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 form is required to be filled out by students actively enrolled in PEAC 30.  

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 is used so that the Instructor can communicate with a third party to confirm that the student is participating in his/her chosen activity for a minimum of three hours per week. A proctor can be a family member, co-worker, instructor, etc.  If you have any questions regarding the Proctor requirement, please contact your instructor.

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