Fill - Free fillable EC-Proctor-Approval-Application-Fillable-Form - UWF Proctor Approval Application.pdf PDF form

UniversityofWestFlorida

Emerald Coast

PROCTORAPPROVALAPPLICATION

SectionA.(Tobecompletedbythestudent)

1. StudentContactInformation

Name:___________________________________________Daytimephonenumber:_________________________________

Emailaddress:____________________________________

Eveningphonenumber:__________________________________

2. CourseNumber(s) Instructor(s) Scheduled Date/Time of Exam

_______________ ___

________________ ______________________________

_______________ _________

__________

________

______________________

_______________

_________

__________ ______________________________

3. SemesterandYear:Fall20____Spring20____Summer20____

4. TheproctoringserviceorindividualthatIamsubmittingforapprovalis(checkallthatapply):

___Aneducationofficerorlibrarianatacommunitycollege,university,elementaryorsecondaryschool

___Atestingadministratoratacollege,universityorprivatetestingservice

___AmilitaryLearningCenterormilitaryofficerofahigherranktheabove‐namedstudent

___Other:______________________________________________________________________________

5. Fillintheproctor’s

ortestingcenterDirector’snameandorganization(e.g.,LeonCountyPublicLibrary,BrevardCommunity

College,SylvanLearningCenter):

Name:_________________________________OrganizationName: UWF Emerald Coast

6. I,agreetothefollowing:(1)tolocateaproctorortestingcenterandsetupanappointmentformycourseexam(s),according

to published dates; (2) to arrange for fee payment for the proctoring services, if any: and (3) to submit this form to the

proctorforcompletionandtoprovidehim/hertheinstructions.TheinformationinSectionAiscorrecttothebestofmy

knowledge.

StudentSignature:______________________________Date:___________________________

SectionB.(Tobecompletedbytheproctor)

1. Proctor/TestingCenterDirectorName: ___________________________________________________________________

Address: ___________________________________________________________________

___________________________________________________________________

Telephone/Email Address: ___________________________________________________________________

2. PleasecheckYESorNOforthefollowingstatements:

___Yes___NoMycontactinformationmaybemadeavailabletoUWFstudents

___Yes___NoFeesareassessedtostudentsforservicesassociatedwithproctoringtesting

3. I certify that: (1) I will uphold the UWF Academic Conduct Standard that includes any and all forms of cheating, e.g., falsely

impersonating another student to gain access to the exam, assessing exam aids not permitted by the instructor, giving or

receivingassistanceofanykindduringtheexam,and/orattemptingtoleavetheexamareawithquestionsoranswers.(2)I

have internet access or email at the testing site that will allow me to download or receive PDF files and print them. The

informationinSectionBiscorrecttothebestofmyknowledge.

ProctorSignature:_________________________________Date:_________________

Please attach and email this form to arymer@uwf.edu or tschwingle@uwf.edu

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