Proctor Certification Form
*This form is to be filled out by the proctor

This certification will be valid for one school year, at which point you will need to complete a new form to remain a certified proctor for our school.


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Email *
School Year *
Proctor Name *
Email Address -we would prefer to send the exams and receive them via email, but please let us know below if this doesn't work for you and we would be happy to mail them. *
I Prefer the exams to be *
Address (please list your full mailing address that exams should be sent to) *International students will be emailed only.
Phone number *
Name of Proctoring facility *
Student Name *
I certify that none of the following applies to me.   Proctors may NOT be any of the following: Relative or friend of the student, Employer of the student, Personal tutor of the student, Ecclesiastical leader if related to the student, Athletic Coach, assistant coach, athletic administrator, or athletic academic counselor, Someone with a vested interest in the student eligibility to compete in extracurricular activities (i.e. sports, theater, choir, etc.) *
Please select your title from the list below *
Policies and Procedures                                                                                       1. The exam must remain with the proctor until the student is ready to take it, and the exam should never be in the student’s possession except when they are taking it. 2. Students may use approved materials, including notes, books, or other references specified by the teacher. Approved materials will be listed on the test copy. Please examine the test beforehand to be sure of what is and is not allowed. Students cannot take notes on the exam or have any part of it to study after taking it. The exam cannot be duplicated in any way. 3. Proctors must collect all papers and questions at the conclusion of the exam. All materials, including exam questions, signed cover sheet, and any scratch paper must be sealed and mailed back BY THE PROCTOR in the envelope provided. 4. The exam must be emailed/mailed back to the school by the specified return date whether the student has taken the exam or not. 5. If the requested proctor is unable to proctor the exam, please call the school to certify another proctor. Do not hand over the exams to another person ESPECIALLY NOT the parent or the student. 6. Exams should never be in the possession of the student’s parents. Proctors, please do not ask them to email or mail them back to the school. Parents can be present as the student is taking a test but there should not be any communication. Parent to proctor is allowed. 7. If the student is suspected of cheating, please call the school immediately. 8. The proctored test may be retaken once for credit, however, it MUST be retaken with a proctor. 9. Cell phones are not allowed to be visible while the student is taking an exam. 10. Due to COVID-19 if you are proctoring over some form of video format, you must always be able to see the student and the test. If your student needs to do exams over some sort of video format, please contact the school for specific guidelines/instructions to help keep the integrity of the test.
I certify that I have read the above policies and procedures and that I will follow them to the best of my ability. *
I certify that I have completed this form for myself to become a certified proctor with Liahona Academy. *
I certify that all information is accurate and that I have not intentionally provided false or misleading information. *
Electronic Signature and Date *
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