For an individual proctor near my home or work
Keep a copy of this form for your records
By submitting this form, I attest that all proctor information contained on this form is correct and conforms to the guidelines for suitable proctors. I have read the guidelines and agree to abide by all rules and regulations set forth by the College. I understand that any deliberate misstatement of fact may result in my dismissal from Thomas Edison State College and a grade of “F” being assigned for any and all courses—past and present—in which examinations were taken under such misstatement.