The student listed below is enrolled in an online biology laboratory course (Bio 100) at Mesa Community College, Mesa Arizona. As part of the course requirements, he/she must take a proctored midterm and final examination. This student has notified the Bio 100 instructor that you are an appropriate proctor and are willing to proctor these two exams for him/her.
For each examination, the two of you will set a mutually agreeable date for the examination within the dates specified on the course calendar. The instructor will mail the exam to you. The student has two hours to complete the exam in a quiet place in which he/she can work undisturbed and be observed. He/she has access to paper and pencil only. The student does not have access to notes, a computer, or textbook when the exam is administered. You will mail the completed exam back to the instructor.
In order to proceed, we need some information from you. Fill in the information online and submit this form. Alternatively, you can print this form, fill out the information using a pencil or pen, and mail it to the instructor listed below, Life Science Department, Mesa Community College, 1833 W. Southern Avenue, Mesa, AZ 85202.
Bio 100 Student Name
Bio 100 Instructor's Name
Proctor's Name
Proctor's Telephone Number (include area code)
Proctor's E-mail Address
Proctor's Institution (Place of Employment)
Proctor's Job Description at this place of employment
Yes, I have read the information above and understand what is involved in proctoring the midterm and final exams for Bio 100 online.
I have read the information above but I still have some questions as noted in the textbox below.