Proctoring Request :: DePaul University Libraries

* indicates a required field
*Name:
	Are you a DePaul student taking an online course at another institution? YesNoIf yes, DePaul ID Number:
	Note: non-Depaul students will be charged a fee of $50.00 for the first two hours and $25.00 for each additional hour (cash or check only; checks made payable to DePaul University Libraries).
Daytime phone:
*Email address:
Address line 1:
Address line 2:
City:
State:
Zip Code:

INFORMATION ABOUT THE INSTITUTION SENDING EXAM
*Institution name:
*Contact Name:
*Contact Title:
*Address Line 1:
Address Line 2:
*City:
*State:
*Zip Code:
*Email:
*Daytime Phone Number:

SCHEDULING
*Course Title and Number:
*Length of exam (time allowed):
	Do you have a deadline for completing the exam?YesNo If yes, please specify:

Preferred Dates/Times To Take Exam (Monday-Friday only):
*First Choice:
*Desired Date:
	10:00am2:00pm
Second Choice:
Desired Date:
	10:00am2:00pm
Third Choice:
Desired Date:
	10:00am2:00pm
Materials Allowed (books, notes, calculator or other):
Special Requirements (specify):