Remote Proctoring Event Review Request

Please complete this form completely if you have a question or concern about your recent remote proctored exam attempt. Please be aware that exams terminated by a proctor due to security violations or disregard of repeated warnings during the exam are not activities that warrant free retake consideration. By submitting this form, you acknowledge that verified violations of this nature may be reported to your institution.

Examinee/Tester Information:

First name*

Last name*

Street address*

City*

State/Region*

Zip code*

Email*

Daytime Phone Number*

Name of school, training center or employer offering your certification program? *

Where in the Live Remote Proctoring Experience were you when you encountered your question/issue?

Select One*

Exam Date*

Year/Month/Day

Details of the Incident:

Please describe the situation you are asking NHA to review. Include all pertinent details about your setting, computer equipment and specific concerns, so NHA can promptly review your exam session and provide a thorough reply to your inquiry.

Type Details Below*

Acknowledgement of Request:

By submitting this request, I understand that an authorized NHA representative acting upon this request will review my remote proctored exam session with the goal of resolving my concerns within 3 business days. I also understand that exams terminated by a proctor due to prohibited behavior during the course of the exam, or other identified rule violations, may be reported to my institution where warranted.

Country/Region