Online Exam Proctor Form

(to be filled out by proctor)
Student Name:
Exam Name (include Class Name and Midterm/Final):
Course Number:
Proctor Name:
Proctor Email:
Proctor Phone:
I verify that:
  • the student took the exam on   (date).
  • I logged the student into the exam at   (time)
  • the student used no notes or books (unless as stated on the exam itself)
  • the student took the exam in one sitting, without interruption
  • the student finished the exam at (time), and that this is within the allotted time specified on the exam.
The above exam was taken under my supervision and in accordance with the guidelines listed above.
Proctor I. D. code
(if given)*:
Student I.D. number
(found in Course Registration e-mail)**:
** Must be included.
Please send comments or questions to

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