Alternate Proctor Request

Student Contact Information
Course Number-Section Exam Name Exam Date Operations
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Facility Type
Facility's Physical Address
State/Province
Primary Contact
  • I have verified with the facility that they provide all software necessary to administer my exam (e.g., Microsoft Excel, Word, etc.).
  • I have verified with the facility that they are available to proctor my exam during the dates specified above.
  • I acknowledge that I have no current or previous relationship (direct supervisor/coworker, blood relationship, or friendship) with the proctor or proctoring facility staff.