Proctored Online Assessment Form
Complete this form to participate in your proctored online assessment. Please ensure all information is accurate and follow the instructions carefully.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Candidate ID (Last 4 digits only)
*
Assessment Name
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Proctor's Full Name
*
First Name
Last Name
Proctor's Email Address
*
example@example.com
Assessment Environment Verification
*
Quiet, private, and well-lit area
No unauthorized materials present
Proctor present throughout assessment
Assessment Questions (Answer all that apply)
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The instructions were clear
1
2
3
4
5
The assessment environment was secure
6
7
8
9
10
The proctor followed all procedures
11
12
13
14
15
I was able to complete the assessment without technical issues
16
17
18
19
20
Rate your overall assessment experience
*
1
2
3
4
5
Short Answer: Describe any challenges you faced during the assessment.
Candidate's Signature
*
Submit Assessment
Submit Assessment
Should be Empty: