Test Proctoring Request Form

2. Test Proctor Request Disclaimer
   Requests must be made at least 3 BUSINESS DAYS (MON-FRI) IN ADVANCE of test date. All requests not adhering to this will be automatically denied.

   Requests must be made at least 3 BUSINESS DAYS (MON-FRI) IN ADVANCE of test date. All requests not adhering to this will be automatically denied.

4. Student Name:

6. First Name*

7. Last Name*

9. Student Phone:*

11. Student Email:*

13. Student Zip Code:*

15. School/Institution Name:*

17. Instructor Name:

19. First Name*

20. Last Name*

22. Instructor Phone:*

24. Instructor Email:*

26. Test Information:
    If unsure of date, time, and/or length, please give an approximate time, or say "to be scheduled".

    If unsure of date, time, and/or length, please give an approximate time, or say "to be scheduled".

28. Expected Date:*

29. Expected Time:*

30. Expected Length:*

32. Type of Test*

    1. Online - Proctor logs you in
    2. Paper - School will send to proctor, proctor will return via mail or scan/email to instructor
    3. Other - Please explain below

34. Other:

36. Special Needs:

    1. Access to public computer
    2. Other - Please explain below

38. Other:

40. Comments:

    Please explain anything else the test proctor needs to be aware of prior to the test.

42. Please read before submitting the form:
    Test Proctoring Policy

44. Click the link above to read our Test Proctoring Policy:*

    1. I have read and agree to the terms of the Test Proctoring Policy

Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field