Jackson State University
ctor name E-mail address
Proctoring site Contact#
I have initialed beside each of the following statements as an indication of my understanding and
acceptance of my responsibilities in my role as proctor:
The testing site will be available for the duration of the testing period for the student(s).
I will provide a secure and appropriate environment for testing.
I will verify the identity of each student using an official university or government provided
identification (e.g. college/university ID, drivers’ license).
I will not provide anything other than supervision to the student(s).
I will ensure that the integrity of the exam is not compromised.
I will make a written report to the instructor or test administrator of all testing improprieties
observed, including the identity of the student(s) involved.
I will abide by the instructor’s/ test administrator’s instructions for administering the exam.
I will not allow the student(s) to use any supplemental materials during the exam, unless
authorized to do so by the test administrator/instructor.
I will retain confidentiality of this exam from all persons except the test administrator/
I will verify after each exam that the student(s) took the exam.
Proctor signature Date
mments or Information Request:
Return this completed form to email@example.com. Phone: (601) 979-0779 or Fax: (601)