Name: ____________________________________________________ University ID#: _____________________
Address: ______________________________________________ City/State/Zip: _____________________________
Email Address: ___________________________________ Telephone: _________________ Cell: _________________
Semester: January 20___ February 20___ March 20___ April 20___
May 20___ June 20___ July 20___ August 20___
September 20___ October 20___ November 20___ December 20___
Course Title: __________________________________________________ Course Code: ______________________
Check a box only if you wish to take the pen/paper version of your exam(s). If testing online through OPS, you can schedule an
appointment at www.proctoru.com/portal/tesu/
I am using Option A for my pen/paper exam with an individual proctor near my home or work.
(Send completed information on Page Two of this form to email@example.com or submit it by mail or fax.)
I am using Option B for my exam at Thomas Edison State University in Trenton, NJ.
(Submit Page One of this form online at forms.tesu.edu/dfprocto.php and then reserve a seat on one of our test dates in Trenton by
using our Web-based scheduling option at www.it-frontdesk.com/resv/tesu/
. Schedule both your midterm and final early in the semester.
You can take your exam in the pen/paper format or online in the University’s Computer Center at 111 W. State Street in Trenton, NJ
Taking your exam(s) online through our Online Proctor Service (OPS) is an option in all courses. Submitting a Proctor
Request Form is necessary only if you wish to take the pen/paper version of your exam(s).
This form should be submitted to the Office of Test Administration by the end of the first week of the semester even if you
are using the same pen/paper proctor as in previous semesters. Otherwise, your exams will not be mailed.
Refer to the “Student Handbook for Guided Study Courses” to learn all options for finding a proctor for your pen/paper
exam(s) before you make a selection.
If you selected Option A with a proctor you have used in the previous semester, you must still list his/her name, mailing
address, and phone number on Page Two of this form.
If you need information on a reasonable accommodation for a verified disability, contact the Center for Disability Services at
(609) 984-1141, ext. 3415.
PROCTOR REQUEST FORM
Complete form and send to firstname.lastname@example.org or submit by fax (609-777-2957) or mail:
ATTN: Proctor Request
Office of Test Administration
Thomas Edison State University
167 W. Hanover St.
Trenton, NJ 08608
If you do not receive an email verfication within 5 business days of submission, contact OTA at email@example.com