Fillable Alternative Proctor Request Form Proctor Request Form.pdf (Virginia Western Community College)

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Alternative Proctor Request Form Proctor Request Form.pdf (Virginia Western Community College)

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Alternative Proctor Request Form
Students, use this form to request an alternative proctoring location.
Students living outside the area or having difficulty using one of the official Virginia Western Testing Centers
may request an alternative location to complete a proctored test or assignment for an online course.
Instructors have final approval and may reject any proctor or location at their discretion. (See Off-Campus
Proctored Testing Policy https://virginiawestern.edu/about/policies/I-61.php)
Directions:
Identify a potential proctor and location and complete this form in its entirety, including the signature of the
proposed proctor agreeing to the proctoring terms. Forward to your instructor for approval. A separate form
must be completed for each online course. Learn more at: https://www.virginiawestern.edu/learning/testing/
Student Information:
Student ID:
First Name: Last Name:
Telephone: VWCC Email Address:
Reason for requesting a proctor:
Instructor Information:
First Name:
Telephone:
Last Name:
VWCC Email Address:
Fax:
Semester:
Course Information:
Class, Number, &
Section: (Example:
ENG.111.V1)
(Example: Fall 2013)
Proctor Information:
Proctor Title:
Proctor Name:
Relationship to Student:
Name of Organization:
Phone:
email:
Fax:
I wish to use an online proctoring service. *
*Students must send completed form to Testing
Center testingcenter@virginiawestern.edu
1 of 2
Revised August 2019
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Student Responsibilities
• Follow the instructions located at the top of this form.
• Pay all fees associated with using an alternative proctored location or online proctoring service.
• Follow all procedures and policies required by the instructor.
Alternative Proctor and Location Guidelines I-61: Off-Campus Proctored Testing
Other Virginia Community Colleges with a testing center may be an easy option.
Other locations may include college, university, or private testing centers; public or academic libraries;
or private office space that meets these standards.
Military personnel should contact the education officers at their duty station.
Alternative proctor locations must be conducive to testing or academic activities while maintaining
the integrity and security of the academic process.
A proctor should be an employee of an educational institution (high school, college or university), a
private or commercial testing center, or a government institution (public library, government office,
etc.).
The proctor should have no conflicts of interest in upholding the Academic Conduct policy as outlined
in the
Student Conduct Policy.
The proctor should not be a relative, friend, fellow student, co-worker, immediate supervisor, or
coach.
Proctor responsibilities:
• Verify the identity of the student through a Virginia Western Student ID or another government
issued photo ID in order to complete the proctored activity.
• Monitor test-taking and ensure the integrity of the testing process.
• Return test and related materials to the instructor at Virginia Western via mail, email or fax. The
student should provide all postage and envelopes for test return. The test should be mailed to the
instructor by the proctor, not the student. If the test is taken through the Learning Management
System (LMS), there may be no materials to return.
I agree to proctor the test according to the proctoring procedures listed above.
Proctor’s Signature Date
Instructor’s Signature Date
2 of 2
Revised August 2019
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Alternative Proctor Request Form Proctor Request Form.pdf (Virginia Western Community College)

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Completed 20 July 2020

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