On Demand Off-site Exam Request

Exam Request at site other than the Distance Learning Testing Center

Before filling out and submitting this form, please make sure you have submitted all assignments in accordance with the course syllabus prior to the exam. If you have any questions concerning your exam contact On Demand at (270) 745-4158.
It is your responsibility to make arrangements with the center at which the exam will be supervised.
If you are taking semester based online courses from WKU, KYVU, SREB, or need other proctoring services, do not use this form. It is only to be used for On Demand course examination requests.
Items noted with an *asterisk are required.

IMPORTANT: You must present a valid photo ID before being allowed to take your exam.

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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