Proctor Approval Request - City University of Seattle
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PROPOSED PROCTOR APPROVAL REQUEST
Student must provide a stamped envelope for the proctor to mail this form to the instructor.
A test proctor is the person responsible for administering your exam. The exam may be proctored at or by one of the following: 1) Library or 2) Education testing officer (military only) or 3) a responsible professional, such as local schoolteacher, proctors at local testing centers, HR personnel, or supervisors, who is not a relative, a friend, a coworker, or a fellow student, and they agree to:
1. Receive the exam materials
2. Administer the exams in compliance with instructions provided by course instructor on the dates indicated
3. Return completed answer sheets in a timely manner
All proctors will be pre-approved by your instructor. The assignment of the proctor is based on his/her availability, reliability, and impartiality. The exam is mailed directly to the test proctor. You must present a valid picture ID to the proctor when taking the exam.
TO BE COMPLETED BY THE STUDENT: Please type or print CLEARLY.
|Your Name: Student ID: |
| |
|Course Name: |
|Instructor’s Name: |
|Instructor’s Address: (Street address, City, State & Zip code) |
| |
TO BE COMPLETED BY THE PROPOSED PROCTOR:
|Proctor’s Name: Title: |
| |
|Signature: Date: |
|Company Name: Telephone: |
|Address: (Street, City, State, ZIP) |
|Please attach a copy of proctor’s ID with a signature on it. Please attach a business card, if available. |
TO BE COMPLETED BY THE INSTRUCTOR:
|The proctor you proposed above is: Approved: □ Disapproved: □ |
|Instructor’s Signature: Date: |
This form is not needed if proctoring your exam at a City University of Seattle campus.
CityU.edu
888.42.CityU
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