Leesville Proctor Request Form

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Proctor Hours: 8:30 am OR 1:00 pm Monday – Thursday and 8:30 am ONLY on Friday.

It is the student’s responsibility to send the proctoring information and confirmation to the Instructor.

Every field must be completed in order to send this form.

    First & Last Name:

    NSU Student (Select One):

    Phone Number:

    Email Address:

    Date Exam Requested (ex. Jan 01 1884):

    Time Requested:

    Length of Time Required for Test:

    Course Number:

    Professor's Name:

    Professor's Phone Number:

    Is Professor on the Leesville Campus?

    Which campus do you want to test?

    I am registered with the Office of Accessibility and Disability Support and Programming.