Proctor Agreement | Information Technology Services

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 Agreement

First Name Required

Middle Initial Required

Last Name Required

Position/Title Required

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.

Address 1 Required

Address 2

City Required

State Required

Zip Code Required

Proctor Work Phone Required

School/Organization Email Required

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

A relative to the student I will proctor Required

A supervisor of the student I will proctor Required

I certify that I meet the following criteria.

Select one

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

Student Information

First Name Required

Middle Initial

Last Name Required

Student Email Required

Course Required

First Exam Date

Agreement

Yes, I agree.