Proctor Agreement

Please review the Proctor Agreement information below and Article III, Part B 1-4 found on pages 3 & 4 of the Student Code of Conduct before filling out the information below.

By checking the "I Agree" box below, you are accepting all terms and conditions stated above.

Required fields are marked with an asterisk *

Proctor Information

First Name Required

Middle Initial

Last Name Required

Position/Title Required

I certify that I am not (check all that apply) Required

A relative to the student I will proctor

A supervisor of the student I will proctor

I certify that I meet the following criteria (select one) Required

Individual active in the educational field (elementary, secondary, or college) as a teacher, a counselor, librarian, extension agent, or an administrator at any level, unless otherwise directed by the course instructor

Supervisor of local testing center

Test control officer or superior commissioned officer serving as a proctor for military personnel

American embassy or consular official

Nebraska Extension Educator

School/Organization Information

Exam Information is sent only to a school, institution, or organization email address. Complete contact information is needed as part of the verification and exam dissemination process.

School/Organization Name Required

Address 1 Required

Address 2

City Required

State Required

Zip Code Required

Proctor Work Phone Required

School/Organization Email Required

Student Information

First Name Required

Middle Initial

Last Name Required

Student Email Required

Course Required

(Example: MRKT335)

First Exam Date

Year

Month

Day

Agreement

Proctor

Yes, I agree.

Leave this field blank