Instructor's Requirements/Directions
For Proctor
Instructor: Please use the form below to request a proctor

Institution	Test Site


Requestor's Name	Department


Mailing Address


City	State		Zip


Phone (xxx) xxx-xxxx	Fax (xxx) xxx-xxxx


Email address


Name of Test


Course Name	Course Number


Proctor Site Authorization/Confirmation


Deadline xx/xx/xxxx	Time Limit
	Hours	Minutes

Format: Online Paper

If online, URL of test


If applicable, what is the username?		Password?


If paper-based exam, how many pages is the exam?

If paper, return deliver by: Mailing address Fax Email attachment

Return to instructor by the following date:

Student(s) Name


What forms of identification are acceptable?


What resources/items can the examinee have in the examination area (i.e. open book, highlighters, calculators, etc.)?


What specific instructions does the faculty member have for the proctor when administering the on-line exams?


Additional Information