NOTE: An examination proctor is a responsible individual who is NOT a relative, spouse/partner, friend, neighbor, coach, co-worker/business associate, direct supervisor, or resides in the same household of the student.

I certify that by entering my name and today's date below, I am the officially enrolled GCSC student identified on this examination. I attest that all proctor information contained on this form is correct and conforms to the guidelines for suitable proctors. I understand that any deliberate misstatement of fact may result in my losing the privilege of using GCSC proctoring and a grade of "F" being assigned for any and all courses-past and present-in which examinations were taken under such misstatement. I acknowledge that it is my responsibility to locate a proctor, schedule my exam appointments, and pay for any proctoring service fees required.