Off-site Exam Request

Click here for a list of proctors in the state of Kentucky. (Link opens in a new window)

If you see this don't fill out this input box.

* Exam # or Name

* Requested Exam Date

* Requested Exam Time

* Course ID #

* Course Instructor

* Name

* Email Address

* Student ID Number

* Phone Number

* Address Line 1

Address Line 2

* City or County

* State

* Zip Code

* Proctor's First Name

* Proctor's Last Name

Administrative Title

* Institution Name

* Institution Address 1

Institution Address Line 2

* Institution City/County

* Institution State

* Institution Zip Code

* Institution Phone

* Institution Email

* Confirmation

I have contacted the person listed above and have set up an appointment for the time and date shown on this form.

I understand that test materials or passwords will be provided to my chosen location no later than 24 hours before my scheduled appointment.

Information about accreditation can be found through the Office of the Provost.

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