Form Agreement Email Addresses

							                                              Proctor Agreement Form

All students taking a course via distance education are required to select a person to proctor and physically supervise their
course exams. The Proctor will be responsible for receiving exams via email, following the guidelines for administering
the exam and returning the completed exam back to EOL. Proctors can keep the completed exam in a locked file and
shred when the semester is over.

Your proctor must be someone who can fulfill the requirements of a proctor objectively. In order to maintain academic
integrity and quality in courses taught by distance education, please do not submit the name of a relative, close friend,
general co-worker, neighbor, etc. Possibilities for proctors include, but are not limited to, human resources personnel, a
supervisor, a librarian, minister, principal, or superintendent. We require the proctor’s email to be one of a business
address and will not accept personal email addresses such as yahoo, gmail, hotmail, etc.

If the proctor you have submitted is not acceptable, we will let you know so you can select a different person.

                              Please complete this form and submit it before classes begin to:

                                             Engineering Online Learning
                                                  Email: eol@iastate.edu
                                                   Fax: (515) 294 6184

                Please provide the following information for the person you wish to serve as your proctor:

Student Name: _______________________________ Course(s): _________________ Semester:___________________

Proctor Name: _____________________________________________________________________________________

Company: _________________________________________ Title: _________________________________________

Address: __________________________________________________________________________________________

Phone Number: ____________________________________ Fax Number: ____________________________________

Proctor Email Address: ____________________________________

Relationship to Proctor (i.e. supervisor, HR personnel, etc.): _________________________________________________

Proctor and Student Agreement:

I have read and I understand the section on plagiarism from the ISU Student Handbook. I understand that any work
completed or submitted by me in the EOL program may be submitted to an electronic database to check for plagiarism,
and that any work so submitted will be added to that database. I understand that the minimum penalty for plagiarism is a
failing grade on the plagiarized assignment. I further understand that plagiarism may result in me receiving a failing
grade for the course involved or in termination from the program. I affirm that all work completed or submitted by me to
be original work, except where clearly documented. Under no circumstances is the student allowed to have a
copy of the completed exam. The proctor (not the student) is expected to forward the completed exam
back to ISU. Please ensure the student is not copied on any emails that contain the completed exam.


______________________________                                             ___________________________________
Student Signature & Date                                                   Proctor Signature & Date


                          If you have any questions, please contact EOL at (800)-854-1675