Distance Learning - Lewis-Clark State College

This is not a secure page. You may register online by filling out and submitting the proctor form below.

1. All proctored exams must be administered in an educational or professional setting.
2. Students are not allowed to use personal computers or laptops for proctored tests.
3. A new form must be submitted for each test to be proctored. Please remit form one week prior to test date.

Either the student or the proctor may fill out this form.
All the following information is necessary for us to verify your name and address. Please do not skip any fields. Any form without all fields completed will not be accepted.

Student Name:

Course Title and No:
                                        Example: Bus 101-60

Instructor Name:

Which Exam needed:
                                        Example: Exam 1, 2 or Final

Proctor Name:

Proctor Title :
                              Example: Dean, Principal, Judge

Business Name:

Mailing Address:


Relationship to student:

Numbers of years known:

Daytime Phone:

Daytime Fax:

E-mail Address:

If you have any questions or concerns, please don't hesitate to call 800-879-0458 or e-mail dl@lcsc.edu.

Proctor Information Form