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Application for Proctor Appointment
To Conduct IMI Certification Testing

I have thoroughly read and understand the policies and proceedures for conducting IMI certification testing, and agree to comply with them. I will make every effort to prevent cheating and will report any incidents of dishonesty to the education committee.

I understand the importance of timely scoring and reporting of exam results, and will promptly return all testing materials to the IMI independent scoring organization, including all used and unused exam books.

I will ensure the proper conduct of all exams, which I proctor. I understand that my appointment as proctor cannot be delegated to others.

I further understand that my appointment as proctor for these examinations can be withdrawn by IMI at any time if I fail to follow required proceedures.

_________________________ (type or print your name) ____________________________ (organization) ____________________________ (address) ____________________________   ____________________________ (signature)

_________________________ (date) _________________________ (office phone) _________________________ (office fax) _________________________ (e-mail address)

Print and return this form to the IMI International office with a letter from your chapter president, supervisor, or department head, on letterhead stationary, requesting your appointment as a proctor and confirming your qualifications to conduct the exams.