OFF-CAMPUS TESTING PROCTOR REQUEST FORM
Please complete the following form and send by mail, fax, or email to the following address. Additional information
included on next page.
Jefferson College of Health Sciences
Student Affairs
Educational Testing Center Coordinator, Room 508
101 Elm Avenue, SE
Roanoke, VA 24013-2222
Email Address: neroberson@jchs.edu
Telephone Number: (540) 224-4895
Fax: (540) 985-8001
Part I: To be completed by the student
Student Name:
Contact Phone #:
Email Address:
Course/Semester:
Instructors Name:
Justification for
Request:
Part II: To be completed by the proctor
Proctor Name:
Title:
Place of Employment:
Office Address:
Office Phone:
Email Address:
Fax Number:
I agree to serve as the proctor for the student identified above. As test proctor, I will receive, administer and
return all tests according the directions provided. I certify that the student will complete the test according to
the directions provided. I certify that I am not related to the student.
Signature ________________________________________
Part III: To be completed by the Educational Testing Center
Date Received:
Approved or Denied:
Date _____________________________
Initials:
Test Proctor Information for Students
1. Proctor Description
If you are unable to travel to campus to take your tests that are scheduled on campus, you may need a proctor. A proctor
is an individual who agrees to receive your tests from JCHS, administer them to you in a suitable environment, and return
them to JCHS in a timely fashion. The proctor will certify in writing to the college that you completed the test according
to all the specified directions provided.
2. What does a proctor do?
A proctor is a liaison between JCHS and its students to ensure that testing is done under secure conditions. The proctor:
 Receives and administers the exam
 Ensures the identity of test-takers by requiring picture identification
 Maintains proximity with and is able to observe the student during the entire test-taking period
 Ensures the test-takers complete the exam according to the instructor’s directions
3. Who can be approved to serve as a proctor?
An acceptable proctor is someone with no conflict of interest in upholding JCHS’ Academic Honor Code. Relatives,
friends, spouses, neighbors, and co-workers are not acceptable proctors. Examples of appropriate proctors include (but
are not limited to):
 Administrators or librarians at a community college, university, high school, or public library.
 Learning center personnel
 College, university, or private testing center professionals
4. What are the proctor’s responsibilities?
 The proctor must ensure that all necessary technologies are available and working at the proposed testing site
(See question #5, below.) and that the testing environment is quiet and conductive.
 Only the proctor may handle the exam prior to and following its completion.
 No copies of the exam other than the copy used for test-taking are to be made at any time
 No person other than the proctor and student may view the exam.
 The student may have access to the exam only during the time period allowed by the instructor.
 The proctor must follow the instructor’s requirements for administering the exam. These may include a time
limit, specific allowable equipment, such as a calculator and inclusion or exclusion of books, notes, etc.
 The proctor must prepare the exam (and any relevant materials, e.g., scratch paper) for return by sealing it in
an appropriate envelope.
5. What technology must the proctor have access to at the testing site?
Each proctor must have:
 A valid and working e-mail address
 Internet access for accessing online tests
 A printer
6. What are the proctor request guidelines?
Requests for proctored tests and the individual proctor must be approved by the Educational Testing Center and your
faculty member. JCHS reserves the right to reject requests or proctors for any reason. To request a proctor, fill out the
Off-Campus Testing Proctor Request Form and return it as soon as possible so that your tests will not be delayed.
It is your responsibility to keep in mind test deadlines when requesting a proctor. If approved, your tests or test access
information will be mailed to the proctor within one week of your request. Pay attention to due dates when requesting
a proctor. If you have any questions about the proctoring process, contact the Educational Testing Center at (540) 2244895.
7. Who pays fees?
Any fees related to proctoring including the cost of postage to return tests are the responsibility of the student.
Revised 11/13/15