Montgomery College
Office of E-Learning, Innovation, and Teaching Excellence
Remote Exam Proctor Information Form
Student Name ____________________________________________ MC ID _____________________
Course/CRN ________________________________________________ Date ____________________
Proctor Information (Relatives and friends are not acceptable proctors.)
Name ___________________________________________ Position/title ________________________
Educational institution _________________________________________________________________
Business Address - Street ______________________________________________________________
City _______________________________________________ State __________ Zip ______________
Phone Number during business hours _____________________________________________________
E-mail address _______________________________________________________________________
Please note: the proctor's e-mail address must be included in the verification information submitted if
your course has an online proctored exam. Signature certifies that the enclosed verification information is
authentic and complies with corresponding guideline(s) listed below.
Proctor’s Signature _____________________________________________ Date _________________
THE APPROPRIATE DOCUMENTATION VERIFYING A PROCTOR’S IDENTITY AND POSITION
MUST ACCOMPANY THIS FORM. Review the following information and choose the appropriate
type of proctor and verification information. Submit this form and proctor verification information
to your instructor.
PLEASE MAIL OR FAX THIS FORM ALONG WITH THE PROCTOR’S VERIFICATION INFORMATION
TO YOUR INSTRUCTOR.
A full-time member of the teaching faculty or an
educational administrator of any regionally
accredited institution of higher education.
Submit a photocopy of the front cover of the
institution’s directory or catalog and the page that
lists the proctor’s name and title.
A full-time, state-certified elementary or high
school teacher, or school librarian.
Submit a letter on official letterhead from the
individual’s principal or superintendent verifying
his or her position. A photocopy of a teacher’s
certification is not sufficient.
Any educational administrator who holds a
position similar to a high school superintendent,
supervising principal, principal, or an Intermediate
Submit a page from the directory or catalog
showing the proctor’s title, as well as the
institution’s name.
