English 1B Online
Introduction to Literature
Mr. Jensen

Complete the  box by entering your name, e-mail address, postal address and phone number.  Send the information to your instructor by clicking on the "Submit" button at the end of the proctor form. All proctors must be librarians, military educational officers, college professors, professional proctors (such as our lab aides) or clergy.

The proctor must have a professional email address and phone. The proctor's e-mail address must end in edu, gov, org, or mil.  Home e-mail accounts such as Hotmail, AOL, Yahoo, Verizon, Earthlink, etc. are unacceptable.

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 on-campus exam, 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:
City, State, ZIP
Title of Proctor
 		Business/School Where Proctor Works