Exam Certification Cover Sheet
Proctor Certification (required):
I affirm that I am an authorized proctor and that I am not a friend, relative, coworker, or subordinate of the person taking
this exam. I certify that the enclosed exam has been administered in the manner described in this Exam Certification
Cover Sheet and was completed and collected in the time period specified. I will return the exam directly to the instructor
as stated below.
The exam was given on: Date (mm/dd/yy):
Start Time:
End Time:
Proctor Name (please print):
Proctor Signature:
I further certify that I have reviewed the student’s ID (acceptable IDs are driver’s license or passport) and affirm
that the person who took this exam is the enrolled student.
Student Name (please print):
Proctor Signature:
Proctor Instructions:

Proctors only (not the student) must return this certification sheet and quiz/exam directly to the person and
in the manner specified below.

All quizzes/exams must be proctored (except take-home exams). Proctors are not expected to administer exams
outside normal working hours. However, the test should be given as close to the stated exam date as possible. If
this cannot be accomplished, the student must make alternate arrangements with the instructor prior to the exam
date. Contact the instructor if you have any questions about administering or returning the exam.

Keep a copy of the exam before sending. Be sure that the student’s name and email address is written on the
exam itself. Follow the return instructions below.
Instructor Complete the Following:
Instructor:
Course Name and Number:
Exam Date (date/range of dates when distance students should take exam):
Deadline
Exam Return Date:
Must be received by:
Must be postmarked by:
Comments:
Format
Type:
Quiz
Midterm
Format:
Open book/notes
Final
Other
Closed book/notes
Other
Time allotted for exam: (hours/minutes)
Take Home
Can use computer to take
exam: YES ☐
NO ☐
Return this certification and exam to the instructor/TA using the instructions below. Do not send to BBA office.
Return
USPS Mail
Instructor Name
University of Colorado Boulder
Dept Name
UCB
Boulder, CO 80309
Enclosed: Exam for (student name)
Special Delivery Address (FedEx, DHL, etc.)
Instructor Name
University of Colorado Boulder
Dept Name
1111 Engineering Dr, Room
Boulder, CO 80309Enclosed: Exam for (student name)
Fax # (if permitted):
Instructor phone # (for questions):
Email (if permitted):
Revised 10/24/15