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.
Fee Payment *
Check if you understand that all tests taken require a fee payment of $25.00.
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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