Complete the  box by entering your name, email address, postal address and phone number.  Send the information to your instructor by clicking on the "Submit Answers" button at the end of the proctor form.

ATTENTION:  This is a form to be filled out by students who require proctoring for their tests.   If you are able to come to the scheduled exams you do not have to fill out this form.

In addition filling out this form does not automatically mean your proctor has been accepted.  The proctor will still need to receive instructor approval.  

Finally please remember that the top box is for YOUR information and the bottom box is for your PROCTOR'S information.  You can not be your own proctor.  A proctor for this class must be unrelated to you, and be approved by the instructor.  Any costs related to proctoring are to be born by the student.  The college is not responsible for proctoring fees.

Student Name:		(Always use your real name in this box)
Student Email:		(Enter your exact email address)
Student Postal Address:	Number & Street	Student Telephone Number:
	City, State, ZIP

Proctor Name:		(Always use your  proctor's real name in this box)
Proctor Email:		(Enter your  proctor's exact email address)
Proctor Postal Address:	Number & Street	Proctor's Telephone and FAX Number:
	Proctor City, State, ZIP
Title of Proctor		Has this person agreed to proctor      your test? Yes No