Non-BRCC Instructor - Proctor Request Form
This form must be completed by an instructor or other authorized personnel.
Please give us your name.
Please give us your student's name.
In which course is your student enrolled?
Please provide us with a phone number where you can be reached.
Please provide us with an email address where we may contact you.
Is this a web-based test to be unlocked with a password or will you provide us with a paper test?
What materials are allowed for this exam?
Opening Test Date
When does your test open?
Closing Test Date
When does your test close?
Please type your name as, a digital signature, certifying that the above information is correct.
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