Proctor Request Form


  • A separate request form must be submitted for each course requiring a proctor. 
  • All proctoring appointments must be made at least 7 business days in advance.
  • The proctor will take submission of this form as an indication that the student is aware of and willing to comply with DPL’s Guidelines found here. Submitting this form signifies that you have read and agreed to comply with the guidelines.
Student Name: *
Student Phone: *
Student Email: *
Institution: *
Course Title: *
Instructor: *
Instructor Phone: *
Instructor Email: *
Additional Information:
Enter your email adress if you'd like to get a copy:
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