Proctoring Form Sheet
Please inform the student to bring a photo ID in order to take the test. If the test has no attempts or has not been
picked up by the Instructor, one phone call, one email, or both will be sent to the Instructor to inform him or her of
the test status. If there is no response back by the Instructor, the test will be discarded at the end of each semester.
Instructor’s please fill out the information below.
Student’s Name: __________________________________ Date: ___________________
Instructor’s Name: ________________________________ Class: ___________________
When is the test going to be taken, student’s arrival?
Test Date: _______________________________________ Test Time: _______________
Instructor’s Contact Information:
How would like to be informed when the test has been completed and ready for pick-up? Please check one.
Phone: ____________________________________
Email: _______________________________________________________________
Test Restrictions (including time limit):
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Do not fill out below. Proctor use only.
Proctor’s Name: __________________________________ Date: ___________________
Check Student ID: Yes No
Time Started: __________________
Time Ended: __________________
NOTES:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Proctor’s Signature
: __________________________________________________
