If you have made arrangements to be proctored at a location not affiliated with Ohio University, please complete and submit this form 10 days prior to your test date for EACH examination.

Outside Exam Proctor Information
(Use this form ONLY if you are arranging an exam with a proctor that is not OU affiliated.)

Your Name**
Your Email**
Course
Proctor's Name**
Educational Facility Name**
Educational Facility Address**
Address Line 2
City, State, Zip**
Proctor's Phone**
Proctor's Fax
Proctor's Email
Date Exam Scheduled**

**Indicates a REQUIRED field. Your form will not be processed without this information.

NOTE: If 10 days notice was not given and the exam has to be faxed or emailed the student is then responsible to provide return envelope and the postage costs.