Form

Request a Proctored Exam

Jackson Education Support offers exam proctoring in a controlled environment for online, distance learning, and independent study courses. Proctoring is $10 per exam hour with a 2-hr minimum. Guidelines: (1) Complete a separate application for each course. (2) Expect an invoice email confirming dates within 24-hours. (NOTE: Form submission does not guarantee approval of exam dates and times; full refund of the application fee is provided if we can not accommodate this request.)
Student Name *

Prefix First Name Last Name
E-mail *
Phone Number *

- Area Code Phone Number
Birthday *

/ Month / Day Year
Student ID *

Mailing Address *

Emergency Contact
Full Name *

Prefix First Name Last Name
Relationship *
Phone Number *

- Area Code Phone Number
Course Information
Institution *
Instructor *
Course Syllabus
Do you require disability-based accommodation? *

Yes No
Desired Exam Dates
Exam 1 *

- Month - Day Year
at
: Hour Minutes
Length of Exam 1 *
Exam 2

- Month - Day Year
at
: Hour Minutes
Length of Exam 2
Exam 3

- Month - Day Year
at
: Hour Minutes
Length of Exam 3
Exam 4

- Month - Day Year
at
: Hour Minutes
Length of Exam 4
How did you learn about this service?
Please consent to the following. *

I consent to receive emails from Jackson Education Support. I consent to First Aid administration in the event of an emergency or injury and assume full responsibility for resulting liability. I understand that students must arrive 10-minutes early and rescheduling a missed exam requires separate payment. I agree to abide by the test-taking policies of my instructor and institution.
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Request a Proctored Exam