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Program Title*
Include even if soft hold
Date(s) of Program*
Room Requested*
Program Status*
- Firm hold
- Soft hold
Soft holds expire 2 weeks before date if not confirmed
Set Up Time*

: HH

MM
Program Start Time*

: HH

MM
End Time*

: HH

MM

Includes cleanup & room breakdown
Staff Contact*
Email*
Phone Extension (if applicable)
Presenter (if applicable)
Presenter Email Address
Presenter Phone Number
Questions, Comments or Special Instructions
Comments
This field is for validation purposes and should be left unchanged.

Student Name*
First Last
Email*
Phone
Type of Exam*
Learning Institution*
What format is the exam?*
- Online
- Paper
Proctoring Requirements
Please note whether your learning institution has special requirements for proctors such as proctor registration.
Requested Date & Time*
Please be aware that there is no proctoring on weekends. All exams are dependent on the availability of the proctor.
Notes or Comments
Fees*
- I acknowledge that as of August 1, 2018, proctored exams are subject to a $10 fee. Additionally, I understand that I am responsible for any costs (printing/faxing) associated with my exam.
Scheduling*
The proctor will set aside time specifically for you and may not be able to make adjustments should any requirements not be followed.
- I acknowledge that failure to comply with any requirements may delay the ability to take the exam.
Name
This field is for validation purposes and should be left unchanged.

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