Proctoring Request Form

Last Name

First Name

Student #

Phone Number

Email Address

Institution's Name

Institution's Phone Number

Course Name

Course #

Instructor's Name

How will the exam be administered?

Online

Paper

Not Sure

I HAVE READ AND AGREE to the Proctoring Guidelines for Clarkston Independence District Library.

I understand and agree to fulfill my responsibilities as the student and accept that the
library reserves the right to refuse proctoring at any time should the Guidelines not be followed