Non-BRCC Student - Proctor Request Form
Student Name
Please give us your name.
Your answer
Institution
Please give us the name of your Institution.
Your answer
Instructor's Name
Please give us your instructor's name.
Your answer
Course Name
In which course are you enrolled?
Your answer
Your Email Address
Please give us an email address where you may be reached.
Your answer
Appointment Requirement
Check if you understand that all tests require an appointment which can be scheduled online.
Required
Fee Payment
Check if you understand that all tests taken require a fee payment of $25.00.
Required
Additional Comments/Questions
If you have any questions or comments concerning your test, please let us know.
Your answer
Signature
Please type your name, as a digital signature, certifying that all the above information is correct.
Your answer
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