Online Proctored Certification Exam Eligibility Questionnaire
Use this form to determine whether you meet the requirements and technical readiness for an online proctored certification exam.
Applicant Details
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Certification Exam Information
Certification exam name
*
Exam provider / issuing organization
*
Intended exam date or time window
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Eligibility and Readiness
Current eligibility status
*
Meets all listed requirements
Unsure about one or more requirements
Does not currently meet requirements
Prerequisite completion items
Required training completed
Required course hours completed
Prerequisite exam passed
Program-specific prerequisite completed
Other
Missing requirement(s) or notes
Proctoring Setup and Accommodation
Testing device and internet setup
*
Accommodation or access needs for online proctoring
Screen reader support
Extra time coordination
Captioning or audio support
Keyboard-only navigation
Breaks during the exam
Alternative communication method
Other
Submit Eligibility Questionnaire
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