University of Kentucky
MA 123 Online: Proctor Approval Form

For more detailed instructions, see the proctor instructions.

* required field.


Student's Details:
Student's Full Name: *
Student's Email Address: *
Proctor's Details:
Proctor's Full Name: *
Proctor's Position: *
Proctor's Address:
Address 1: *
Address 2:
City: *
State: *
Zip: *
Country: *
Proctor's Telephone No: *
Proctor's Email Address: *
Test location the same? Yes     No
Proctor for: Exam 1   ---   Yes     No
Exam 2   ---   Yes     No
Exam 3   ---   Yes     No
Exam 4   ---   Yes     No
Additional comments/concerns?
By submitting this form, I indicate that the above information is correct, that I meet the criteria described for a test proctor, and that I will help the student follow the instructions on the instructions page.