SAMPLE PROCTOR APPLICATION FORM
(Sample copy to obtain information from proctor)
1. PRINT OUT this sample application.
2. Please fill in the STUDENT INFORMATION and PROCTOR INFORMATION sections.
3. Once you have the necessary information, go online and complete the online proctor application which can
be accessed by logging into https://support.csis.pace.edu/nactel/proctor/student/index.cfm
4. PRINT OUT the completed online application and give all 3 pages to your selected proctor. The proctor
must sign the application in the presence of a Notary Public for it to be valid.
5. You can omit the notarization requirement and just have your proctor sign this sample form if:
a. Your selected proctor is from an official testing service or learning/tutoring center.
b. Your selected proctor is already an approved proctor in the Pace/NACTEL program.
6. The completed online form should be faxed to 914-989-8602.
7. Make sure you retain a copy of the completed form for your records.
STUDENT INFORMATION
Name:
E-mail Address:
PROCTOR INFORMATION
Name:
Job Title/Position:
Institution where Title/Position is held:
Business Address
Street:
Apt/Room #:
City/Province:
State:
Zip/Postal:
Business Phone Number:
Extension:
Business Fax Number:
E-mail Address (required):
Alternate E-mail address (if one exists):
Relationship to Student:
PROCTOR CRITERIA
In order to be approved as a proctor, the individual must meet one of the criteria listed below. Please select only one. The chosen
proctor will not be approved if he or she is a relative, a student in the Pace University/NACTEL program or a co-worker.
Supervisor within your or any telecommunications firm
Resource/General Manager within your or any telecommunications firm
Corporate Instructor within your or any telecommunications firm
Union Representative/Steward within your or any telecommunications firm
Company President/Vice-President within your or any telecommunications firm
Principal or Superintendent of an Educational Institution, either public or private
_____Official Testing Service of an Accredited University or College (no notarization required)
_____Official Learning/Tutoring Center (no notarization required)
_____Certified College Instructor
_____School Guidance Counselor
_____Librarian
_____Military Educational Officer
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_____Clergy
Law Enforcement Officer (Sergeant, Lieutenant or Captain only)
*PLEASE NOTE: Any fees charged by the proctor will be the responsibility of the student
PROCTOR STATUS (please select one)
I am currently an approved proctor in the Pace/NACTEL program.
I am not currently an approved proctor in the Pace/NACTEL program.
PROCTOR GUIDELINES
A person willing to accept the position of proctor must be a trusted individual who can take on a supervisory role in
the administration of any exam.
The responsibilities of a proctor are outlined below. We ask that all proctors adhere to these guidelines whenever
administering an exam or assignment
1. The student is responsible for making initial contact with the Proctor to make the necessary arrangements for
setting up their Proctor and taking the examination.
2. The Proctor is required to have e-mail and Internet access. Important messages and/or files will be sent via
email as well as accessed directly online via a Proctor Information Center. If you cannot open a file, please
contact the NACTEL office.
3. Please verify the identity of the student by requesting an acceptable form of photo I.D., such as a valid driver's
license.
4. The student may not view the examination prior to the date/time arranged for taking the examination. The
exam must be taken in one sitting.
5. Please provide an appropriate location for taking the examination, free of distractions and comfortable for test
taking.
6. The student is responsible for bringing any necessary supplies, such as pens, pencils and blank paper.
7. The student is only allowed to use any resources indicated on the Proctored Exam Information Form while
taking the examination. Additional resources are prohibited.
8. To access the proctored exam, the student will enter his or her Blackboard course online. When the link for
the proctored exam is clicked, the student will be prompted for a password. The Proctor should enter the
password indicated on the Proctored Exam Information Form.
9. The student should be frequently monitored during the course of the examination to ensure he/she is
completing the exam following all guidelines.
10. The student is permitted to write their answers down during the examination for use in case they get locked
out or lose their Internet connection. The Proctor must take the written answers before the student leaves the
exam location.
11. The student must adhere to the time limit restrictions on the examination. A typical exam period is 2 – 3
hours.
12. Examinations must be accessed/completed by the indicated due date.
13. The proctor is responsible for recording the time the examination was started and the time the examination
was completed on the Student/Proctor Verification Form.
14. Upon completion of the examination the student and Proctor are required to completely fill out the
Student/Proctor Verification Form.
15. The Proctor is responsible for returning the examination (if not directly submitted online – in which most are)
and Student/Proctor Verification Form following the Instructor's directions. An examination submitted without
the Student/Proctor Verification Form will not be valid. The student should cover any mailing costs IF any
exam requires mailing (most do not).
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VERIFICATION
(*only sign this sample application if you do not need to get this notarized, otherwise you will need to
sign/notarize the completed online proctor application once that has been completed by the student)
I, the above named proctor, hereby verify that all information on this application is true to my knowledge. I will assume
my role as proctor in a professional manner and adhere to all Proctor Guidelines when administering an examination.
Proctor Signature:
Date:
Any questions please contact:
Patricia Vogel
Online Testing Coordinator
WORK: 1-914-422-4445
FAX: 1-914-989-8602
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