Off-Campus Proctor Form
The following individuals are permitted
to be a proctor:
The following individuals are not
permitted to be a proctor:
Official Testing Service of a Regionally
Accredited University or College
Coworker
Certified College Instructor
Friends of the student
School Guidance Counselor
Family & Relatives of the student
Principal of an Educational Institution,
either public or private
Law Enforcement Officer
Official Learning/Tutoring Center
Instructions: Please fill out all information listed and return to assessment@aims.edu
PROCTOR INFORMATION
Proctor’s Name:
Proctor’s Job Title:
Place of Employment:
City:
Zip Code:
Business Phone #:
Business Fax #:
Business E-mail Address:
EXAMINEE INFORMATION
Examinee’s Name:
Examinee’s Student ID #:
Examination to be Administered:
By entering my name below, I certify that the following is true: (1) I have truthfully filled out
the information on this form and (2) I have no conflict of interest, as described above, with
the proctor/examinee relationship.
Proctor’s
Signature:
Date:
click to sign
signature
click to edit