Burrell College of Osteopathic Medicine

Name:*

First Last

Current Mailing Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone:*

Note: In order to work as an exam proctors, you must have a telephone with answering machine or voicemail that you check regularly.

Email*

Enter Email Confirm Email

Note: Communicating by email is preferred – to send you updated schedules, requests covering for other proctors.

Gender:*

Ability to sit/stand for long periods of time:*

Ability to climb theatre type steps:*

If you join the exam proctor team, you will complete a W-9 and Direct Deposit form prior to working your first exam.

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