PNF_180328 Additional forms are available in the Student Portal.
Proctor Nomination Form
Semester Exams and/or Life/Work Experience Exams
Student Name: _____________________________________ Daytime Phone: _____________________________
Student Number: ___________________________________ Program: __________________________________
Address:______________________________________________________________________________________
Email Address:_________________________________________________________________________________
Directions for Completing This Form
This Proctor Nomination Form needs to be completed and sent to Ashworth College only once.
If nominating proctors for Life/Work Experience Exams, please return immediately after enrolling with
Ashworth College. (Life/Work Experience Exams are not available for Master’s students.)
If nominating proctors for semester exams, please return this form before completing your fifth course.
(Master’s students need to send form before completing their fourth course.)
You must nominate two proctor candidates. Please use the lines below to enter the names of your
proctor nominees. (You may provide the name of only one proctor candidate only if that person is a high
school or college administrator, faculty member, guidance counselor, librarian or a member of the clergy.)
Please be sure that neither candidate is a fellow student, related to you by blood or marriage, a
roommate, an immediate supervisor, your fiancé, or other acquaintance with whom a conflict of interest
exists.
Each proctor must have access to a computer and the Internet for you to complete your proctored exams.
Student and proctor need to be available three hours before beginning an exam.
Proctor Candidate #1
Name: __________________________________Title/Occupation:_____________________________________
Address: ___________________________________________________________________________________
City:____________________________________State:_______________________Zip:____________________
Daytime Phone:_________________________________ Evening Phone:_______________________________
E-mail:__________________________________________Relationship to Student:________________________
Proctor Candidate #2
Name:__________________________________Title/Occupation:_____________________________________
Address: ___________________________________________________________________________________
City:____________________________________State:_______________________Zip:____________________
Daytime Phone:_________________________________ Evening Phone:_______________________________
E-mail:__________________________________________Relationship to Student:_______________________
It is best to return this form by creating a ticket in your Student Portal.
Other options for returning this form:
Email: education@ashworthcollege.edu / Fax: 770.729.0961
Master’s Students Only: masters@ashworthcollege.edu / Fax: 770.729.7295
Ashworth College – 6625 The Corners Parkway, Suite 500, Norcross, GA - 30092
