University of Great Falls
Distance Learning Proctor Certification

 

Student’s Name:                     _________________________________________

Proctor’s Name:                  _________________________________________

Relationship to Student:        _________________________________________

Proctor’s Mailing Address:   _________________________________________

      (Business address preferred;      _______________________________________________
         please list the business.)           _______________________________________________

Proctor’s Phone Number:        ____________________________________

  Fax Number (if available):       ____________________________________

Proctor’s E-mail (if available):     ____________________________________

I certify that I am willing to serve as volunteer proctor for the student listed below.
I agree to the following guidelines:

1.      I will verify the student’s identification by asking to see a picture I.D.
2.      I will provide a quiet, well-lighted area as free from noise and distraction as possible and within an appropriate supervisory distance from myself.
3.      I will comply with the proctoring instructions attached to the front of the exam sent to me (e.g. time limits, closed-book, etc.).
4.      I will return the exam to the University within the deadline indicated on the exam cover sheet. (The student should cover postage or fax charges.)

__________________________________     ______________________

              Proctor’s Signature                                  Date

Please print out and complete this form, and return it to
Academic Program Assistant
1301 20th St S
Great Falls, MT 59405
Fax: (406) 791-5990

Please Note: If a student fails to provide this proctor certification form at least two weeks
prior to a proctored examination, the resulting cost of express shipping the exam
to the proctor may be charged to the student's account.