Proctoring Form – Bryan College
Proctoring Coordinator: Samuel. J Youngs
To Students and Instructors: In order to schedule a proctoring appointment, the information requested in the following form is required. It can be
completed as a printed hard copy and brought to the appropriate office (Anderson Annex, Top Floor, Center Office) or mailed intramurally (Box
7808); it can also be completed digitally and emailed as an attachment, or the information can be sent directly in the body of an email message, which
will be printed for records.
Instructor and Course Information
Examination Materials and Protocols
By filling out this form, I hereby confirm that I am aware of the student’s
proctoring request, and I approve of the Proctor’s administration of
How long does the student have to take this exam? ___________
these examination materials.
Can the student use any “helps” or materials other than a writing
Instructor name: ______________________________________
implement in the course of this examination? If so, please specify in the
space below:
Instructor department: _________________________________
Course number & title: ________________________________
What is the latest date (as determined at instructor’s discretion) that the
student in question is allowed to take the exam/quiz in question?
___________________________________________
Please list any additional instructions specific to this exam/quiz in the
space below:
How would the instructor prefer for the the exam to be returned to them?
How will the examination materials be brought to the Proctor? (please
(check below; if filling-out digitally, then italicize your preference)
check below; if filling out digitally, bold your preference)
1) Mailed Intramurally?
☐ (Box #________)
I will hand-deliver them to office
☐
2) Dropped-Off to Office? ☐
(Office _______)
I will email to proctoring@bryan.edu
☐
(Note: Exam may be slid under door if instructor is outof-office when exam is returned.)
I will mail intramurally to Box 7808
☐
Student Information:
Name: (Print)______________________________________________ (Sign)____________________________________________
Do you have ADA Accommodations? (circle) YES
NO
(If yes, what are the accommodations? __________________________)
For what day/time have you scheduled your proctoring appointment with the Proctoring Coordinator? ________________________________
Proctoring Form – Bryan College
Proctoring Coordinator: Samuel. J Youngs
To Students and Instructors: In order to schedule a proctoring appointment, the information requested in the following form is required. It can be
completed as a printed hard copy and brought to the appropriate office (Anderson Annex, Top Floor, Center Office) or mailed intramurally (Box
7808); it can also be completed digitally and emailed as an attachment, or the information can be sent directly in the body of an email message, which
will be printed for records.
Instructor and Course Information
Examination Materials and Protocols
By filling out this form, I hereby confirm that I am aware of the student’s
proctoring request, and I approve of the Proctor’s administration of
How long does the student have to take this exam? ___________
these examination materials.
Can the student use any “helps” or materials other than a writing
Instructor name: ______________________________________
implement in the course of this examination? If so, please specify in the
space below:
Instructor department: _________________________________
Course number & title: ________________________________
What is the latest date (as determined at instructor’s discretion) that the
student in question is allowed to take the exam/quiz in question?
___________________________________________
Please list any additional instructions specific to this exam/quiz in the
space below:
How would the instructor prefer for the the exam to be returned to them?
How will the examination materials be brought to the Proctor? (please
(check below; if filling-out digitally, then italicize your preference)
check below; if filling out digitally, bold your preference)
1) Mailed Intramurally?
☐ (Box #________)
I will hand-deliver them to office
☐
2) Dropped-Off to Office? ☐
(Office _______)
I will email to proctoring@bryan.edu
☐
(Note: Exam may be slid under door if instructor is outof-office when exam is returned.)
I will mail intramurally to Box 7808
☐
Student Information:
Name: (Print)______________________________________________ (Sign)____________________________________________
Do you have ADA Accommodations? (circle) YES
NO
(If yes, what are the accommodations? __________________________)
For what day/time have you scheduled your proctoring appointment with the Proctoring Coordinator? ________________________________