Submission of this form signifies that the student has read, understands, and agrees to comply with Graduate School USA's proctored exam requirements. The person acting as the proctor is in a position of trust, thus the proctor application will be reviewed and approved or declined after verification is completed. Once the proctor is approved, both student and proctor will receive a confirmation email at the addresses provided below. Those applications that are incomplete, do not have the required documentation, or do not meet the proctor qualifications will not be approved, and the student will be notified. No exams will be transmitted until a proctor has been approved through this process.
Day Phone #
Home Phone #
Email Address *:
Confirm Email Address *:
Instructor Name, Course, & Course Number *:
Instructor Name, Course, & Course Number:
Place of Employment:
Job Title or Profession:
Relationship to Student:
Proctor Email Address *:
Confirm Proctor Email Address *:
Materials for test will be primarily emailed to the proctor.
Address to mail the examination to if necessary:
* = Required