Exam Request Form

This form is for a WKU semester-based student who is requesting an offsite (KY, another state, international) proctored exam

Before you begin, please note:

• Independent Learning Students — DO NOT USE THIS FORM. Click "Student Exams" on the left side of this page and then select your appropriate exam preference (IL student - onsite or IL student - offsite) from the sub-menu.
• Students who are taking online courses from WKU but wish to take their exams at an offsite location must:
  1. FIRST make an appointment for testing at their chosen proctored site.
  

  • Preapproved proctor sites in Kentucky and in the United States.
  • Students who want their exam proctored at a site not on the list of preapproved proctors (including international sites) will need to make arrangements with a local community college or university.

  2. THEN fill out and submit this form. (* indicates a required field)
• If you have any questions, please call our office at (270) 745-5122 (toll free: 1-800-544-2280) or email us at dltesting@wku.edu.

Exam Information

Today's Date
Exam Number or Name * ( Ex. 1, 2, 3 or Midterm/Final)
DATE Examination is Wanted *
TIME Examination is Wanted * format: hh:mm:ss	AM PM
Course ID Number *
Course Title *
Course Instructor *
Reason you are requesting an exam to be proctored: Reason you are requesting an exam to be proctored: Online Course from WKU Internet Course from KYVU Internet Course from SREC Proctor needed for traditional course exam Proctor needed for course from another institution

Your Contact Information

Your first name *
Your middle initial
Your last name *
Address Line 1
Address Line 2
City or County
State
Country
Zip Code
Your email address *
Your phone number *

Proctor Information

You will need to make arrangements with a local community college or university. Approved supervisory personnel include directors of independent study programs, directors of testing or counseling services, directors of admissions, or academic deans. Non-administrative faculty members would not be approved to receive and administer these exams. Students on active duty in military service, or their dependents, may take examinations under the supervision of their base education officer or someone designated by that officer.

In accordance with the requirements listed above, please give your exam supervision information:

Proctor's First Name
Proctor's Last Name
Administrative Title
Institution Name	(Must be Post-secondary Institution or Military Education Office)
Institution Address Line 1
Institution Address Line 2
Institution City or County
Institution State
Institution Country
Institution Zip Code
Institution Email address
Institution Phone
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.