Proctored Exam Application - C4ISN - School of Management @ UT Dallas

SOM eLearning Office, P.O.Box 830688 – SM27, Richardson, TX 75083
(Street Address: 800 West Campbell Rd. – SOM2.231, Richardson, TX 75080)
Phone: 972-883-5918, Fax: 972-883-6598, Email: som-elearning@utdallas.edu

Proctored Examination Form

Fields marked with an asterisk(*) are required.

*Student's First Name:

*Student's Last Name:

*Degree Program:

Contact Information

*Day Time Phone:

*Email Address:
Example: xyz099000@utdallas.edu

*Exams to be Proctored:

*Exam Scheduled Date:
mm/dd/yyyy

*Testing Center Name:

*Proctor's Email Address:

Example: xyz099000@utdallas.edu

(This form will automatically be sent to your proctor in order to complete. Please make sure the proctor email address is accurate.)