This form must be printed, signed and returned to Richard McKenna.

Richard McKenna Charter High School
1993 E. 8th North
Mountain Home, ID 83647
208-580-2449 -OFFICE
208-580-2450 -FAX
Proctor Verification Form

Proctor: Must be a responsible adult older than 21 who is not related to the student. (Final exams for BYU courses require a proctor that must be currently employed by a public or private school as an educator or office staff, or by a public librarian.)


Student's First Name	Last Name



Proctor's First Name	Last Name	Mailing Address


Job Title	E-mail Address	Contact Phone

To help verify you when you call Richard McKenna, please answer TWO of these questions:

What was the name of your first school?
What was your high school mascot?
What is your all-time favorite sports team?
Who was your childhood hero?
What is your favorite pass-time?
What is your father's middle name?
What make was your first car or bike?
What is your pet's name?
Where did you first meet your spouse?
What are the last 4 digits of your SSN?
What is your birth date



Proctor's Signature	Date

I verify by this signature that the information provided on this form is correct and truthful and that I will follow the testing procedures as outlined by Richard McKenna Charter High School.
Please fax or mail this form WITH A COPY OF YOUR DRIVER'S LICENSE to McKenna Online, 1993 E. 8th North, Mountain Home, ID 83647. Fax: (208)580-2450.

ONCE THIS FORM IS RECEIVED AT THE MCKENNA OFFICE, YOUR LOGIN WILL BE E-MAILED TO YOU.

If you are already setup as a McKenna Online proctor, you do not need to submit this form again, but can simply ask the student to send a school e-mail to the office requesting to have you assigned as their proctor.