Test Proctoring Request Form

About this Service

Users of this service are expected to adhere to the Library's Rules of Conduct and Test Proctoring Guidelines.
Learn more about locations, hours and scheduling.
For more information contact the Reference department at Centerville Library at (937)433-8091, extension 2.

Test Proctoring Request Form

Last Name:

First Name:

Street:

City:

State:

Zip Code:

Preferred Contact Method:

Phone Email

Phone:

Format xxx-xxx-xxxx

Email:

Format xxx-xxx-xxxx

Institution:

Instructor:

Preferred Testing Location:

Type of Test?

Number of Tests?

Test Proctoring Agreement:

(Please check this box to indicate your agreement with the following:)

I hereby request test proctoring services as indicated above. I have read and agree to the Library's Test Proctoring Guidelines including payment of all applicable fees. I agree to notify the Library as far in advance as possible if my test is canceled. I understand that this is not a confirmed reservation and that my request must be approved by designated Library personnel.