Site Accessibility Statement
Wilfrid Laurier University Office of the Registrar
April 21, 2014
 
 
Canadian Excellence

FINAL EXAMINATION - PROCTOR CONFIRMATION FORM


Please print and have the proctor fill out this form with all pertinent details.

Click for printable version.

WILFRID LAURIER UNIVERSITY - OFFICE OF THE REGISTRAR, 75 University Avenue West, Waterloo, Ontario N2L 3C5
519-884-0710 ext. 6098/6370/6359 FAX Number: 519-884-8826
Jessica Bell at Ext. 6098   jebell@wlu.ca or Anne Snyder at Ext. 6370 asnyder@wlu.ca


IMPORTANT: Students are not allowed to change the exam dates and times.

Please note: if you need Accessible Learning Accommodations please contact our office at least 3 weeks before the start of the examination period, in order for us to make arrangements.




Due dates for On Line Learning Proctor Form and Changing exam locations for final examinations:

Winter - February 28, 2014

Student Name : ______________________________ ID Number : _____________________________
COURSE
DATE
TIME
1.    
2.    
PROCTOR INFORMATION
NAME:_______________________________ PHONE NUMBER:_____________________

ADDRESS:

Street :_________________________ Apt.# : ____________ Country : _____________________
City : __________________________ Prov. : ____________ Postal Code : __________________
E-MAIL ADDRESS : __________________________________________
COURIER ADDRESS ( for delivery of the examination to the proctor )
Street :_________________________ Apt.# : ____________ Phone # : _____________________
City : __________________________ Prov. : ____________ Postal Code : __________________
Occupation : ____________________________ Are you retired : ________________
Place of Employment : ____________________________________________________ (Last place if retired)
EMPLOYER ADDRESS :
Street : ____________________________________________Suite # :
City : __________________________ Prov. : ____________ Postal Code : __________________
Telephone Number of Employer : ____________________________
Have you proctored before? ____________ If yes, for what institution : ____________________________
Are you interested in proctoring for other students? : ________________

STUDENT PLEASE READ:
I confirm that I have read and agree to follow the Examination Regulations and Code of Conduct set for the writing of examinations.

DATE : _________ PROCTOR SIGNATURE : ______________________ STUDENT SIGNATURE: ___________________
**ANY PROCTORING FEES CHARGED ARE THE STUDENT'S RESPONSIBILITY**