Testing Services: Distance Education Proctoring Schedule

Student Information

Student's Name:

Student's Birthdate:

Student's Email:

Student's Phone (including area code):

Course Name:  

Course Number:  

Home Institution:  

Instructor Information:

Instructor's Name:

Instructor's Email: 

Instructor's Phone (including area code):

Semester: 

Note:  It is the student's responsibility to make sure the exam is taken during the acceptable time period set forth by the Instructor.

First Appointment: 

Pick an exam: 

If other, please specify: 

First Choice:

Please enter arrival time: 

Second Choice:

Please enter arrival time: 

Second Appointment: 

Pick an exam: 

If other, please specify: 

First Choice:

Please enter arrival time: 

Second Choice:

Please enter arrival time: 

Upon receipt of this form we will send an e-mail to your instructor requesting test materials.

Confirmation of your scheduled appointment will be sent to you by email.