TSU Distance Learning Comprehensive Exam Proctor Form

IMPORTANT NOTICE!

It is the responsibility of the student to find an acceptable Proctor. This Proctor should be someone of high academic standing and MUST accept the responsibility of administering the Comprehensive Exam. All Proctors MUST have an e-mail address and ability to print the exams.

There is a $50.00 fee to take the Comprehensive Exam. Please see payment instructions at the end of the form.

Proctors May Include: Unapproved Proctors Include:
College/University Academic Professionals
(e.g., Professors, Deans, Department Heads, etc.)		 Attorneys
Commercial Testing Center
(e.g., Sylvan Learning Center)		 Immediate Supervisors
Librarians Religious Leaders
(e.g., Clerics, Priests, Ministers, Rabbi, etc.)
Education Testing Officers (ESO/TCO) Secretaries/Office Managers
Secondary School Principals/Vice Principals Administrative Assistants
Superintendents/Assistant Superintendents Student Tutors
School System Curriculum Directors Co-workers
Secondary School and College Counselors Proctor cannot be a TSU student
Human Resources Training/Education Professional Family Member/Relatives

All proctors are subject to approval by the Distance Learning Center.

This Form MUST be completed in full and submitted to the Distance Learning Center by the date indicated on the Class Schedule.

Comprehensive exams remain at the Distance Learning Center until proper Proctors are retained. Students MUST show a valid military ID or state driver's license to Proctor at time of taking the exam.

Student Section:

Student's First Name: M.I.:
Student's Last Name: Suffix:
Social Security Number:
Telephone:
E-mail Address:
Degree Program:
Term Date:

Proctor Section:

Proctor's First Name: M.I.:
Proctor's Last Name: Suffix:
Proctor's Employer:
Work Telephone: Ext:
E-mail Address:
Street Address:
Street Address:
City: State: Zip: -
County: Country:
Qualification to Proctor:

Person Verifying Qualification to Proctor:

A third-party must verify that the proctor stated above meets the qualifications to proctor.

Full Name:
e-mail:
Primary Telephone: Ext:
Secondary Telephone: Ext:
There is a $50.00 fee to take the Comprehensive Exam. Please choose payment method:

If you chose Personal Check or Money Order, please PRINT OUT THIS FORM, and mail this form along with your personal check or money order to:

If you chose Credit Card Payment, after clicking the submit button, please proceed to the Online Secure Credit Card Payment Form found in the Online Forms section of this website. Be sure to choose "Comp Exam Fee" and authorize the Distance Learning Center to charge your credit card $50.00.