Proctoring Request Form

Students are required to complete a proctoring request form. Prior to completing this form, students are required to contact their instructor to ensure they are allowed to use proctoring services. Additionally, students should contact their selected proctor to verify that the proctor is available to administer exams.

Be sure to submit your form at least one week prior to your exam to ensure that requests are reviewed and approved in a timely manner. Our office will not accept proctoring requests via email. Please note, you will need to complete a request form for each course that you want to request proctoring for. If you have any questions about how to complete this form please contact us.

Student Agreement*
I agree that I have read and understand the proctoring procedures as outlined by the Online and Special Programs website. I also acknowledge that Online and Special Programs reserves the right to cancel my request if the aforementioned procedures are not followed correctly.

Term*

Session*

PeopleSoft ID* (7 Digit ID Number)

First Name* (please provide your first name)

Last Name* (please provide your last name)

Yahoo users please enter an alternate email address

Student UH E-mail* email@uh.edu

Confirm Student UH E-mail* email@uh.edu

Student Phone Number* 555-555-5555

Course* e.g. MATH 1310

Class Number* Class Number e.g. 20871

Instructor Name* Instructor Name

Reason for Request*Reason for Request

Exams I Need Proctored: (check All Exams, or if you do not want all of your exams proctored, check all that apply to you; your class might not have as many exams as are listed here)

Company, Institute or Organization* e.g. Lone Star College Testing Center

Proctor Name (if applicable) Proctor Name

Proctor E-mail* e.g. kingwood.testing@lonestar.edu

Confirm Proctor E-mail* e.g. kingwood.testing@lonestar.edu

Proctor Phone Number* 555-555-5555

Proctor Criteria *

To be a proctor, the above-named individual must meet one of the following criteria, and must not be a peer or a member of your family.

Additional Notes/Information

Online & Special Programs

PROCTORING SERVICES

HOW IT WORKS

Exams I Need Proctored: (check All Exams, or if you do not want all of your exams proctored, check all that apply to you; your class might not have as many exams as are listed here)

To be a proctor, the above-named individual must meet one of the following criteria, and must not be a peer or a member of your family.