Alternate Proctor Request

1. Enter your information

Name

Phone

Address

City/Town

State/Province

ZIP/Postal Code

Country

2. Enter exam information

Course Number-Section	Exam Name	Operations
Course Number-Section	Exam Name

more items

3. Enter facility information

Proctor/Facility Name

Facility Type

Address

City/Town

State/Province

ZIP/Postal Code

Country

Primary Contact Name

Primary Contact Email

Phone

Proctor/Facility Web Address

4. Acknowledgments

I have verified with the facility that they provide all software necessary to administer my exam (eg, 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.

Modified Testing Center Hours