Request Proctored Exam

Please fill out the following form to request a proctor for your exam. Be sure to click the "Submit Request" button once you have completed the form.

Requests should be submitted no less than 3 days before your exam.

Student Information

First Name:* Last Name:*
Phone: Email:*  
KCTCS Home College:

Exam Information

Course: (i.e. BIO137) Instructor College:
Instructor Name: Instructor Email:
Instructor Phone #: Exam Length:
(i.e. 2 hours)
Is this request for a NOCTI exam?
Note: NOCTI exams are available on Hazard Campus only.

Campus Request

1st Choice Campus 2nd Choice Campus

Dates and Times

Please list 3 days and times when you are available to take the exam.
Date:  (i.e. 11/04/2011) Time:  
1st Choice:  
2nd Choice:  
3rd Choice:  
Other Comments: