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Remote Site Application

This form must be submitted by the second week of the term.

Remote Site Application

Student Information

First name	Last name
Student ID	E-mail address
Street	City
State/Province	Zip code
Country	Phone number
Reason for requesting a remote proctor site?

Which classes do you need a proctor for? Linguistics 150 (Spring 2008)
Political Science 201 (Spring 2008)
Economics 201 (Spring 2008)
Economics 202 (Spring 2008)
Political Science 204 (Spring 2008)
Political Science 205 (Spring 2008)
Geology 213 (Spring 2008)
Geology 304 (Spring 2008)
Geology 306 (Spring 2008)
Geology 307 (Spring 2008)
Geology 308 (Spring 2008)
Economics 380 (Spring 2008)

Remote Proctor Site Information

First name	Last name
Title	Name of organization/institution
Description of Organization or Institution
E-mail	Fax (optional)
Street	City
State/Province	Zip code
Country	Phone number
Additional notes (optional)

Please make sure this box says DUCKS, we use this to prevent spam

Thank you for submitting your request to the Social Science Instructional Lab at the University of Oregon.