Proctored Test Request Form

Proctored Test Request Form
Students: Please use this form to request a proctored test. Disability Resources will contact your instructor to obtain a copy of your test. If you decided not to use your proctored test accommodation or are unable to make a scheduled test, you must contact Disability Resources.

**Please remember that ALL Proctored Test Requests must be submitted electronically at least 3 business days before the date of the test. If you have trouble, please contact the Disability Resources at 928-226-4323.

Alert: All proctored testing must be completed by 5:00 pm. If you show up late for your scheduled testing time, your time will be deducted accordingly.

If you prefer to turn in a paper version of this form, please download the Proctored Test Request paper version.
- Proctored Test Request paper version Word Document (.DOCX)
- Proctored Test Request paper version PDF (.PDF)
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number
Please enter a valid phone number.
Class Information
Course Name
Instructor's Name
Date and Time Class Takes Test/Quiz

MonthDayYear
Date
Hour MinutesAM/PM Option
Proctored Quiz Information
Proctored Test/Quiz Time and Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Additional Information
Additional accommodations are needed for this test
Should be Empty: