Mount Bashan School · Office of Academic Records & Crisis Education
Official Examination Proctoring Affidavit & Academic Integrity Form
17350 State Highway 249 Ste 220, Houston, TX 77064 · (281) 555-0142 · registrar@mountbashanschool.org
Section 1 — Student Information
Section 2 — Course & Examination Scope
Section 3 — Proctor Qualifications & Attestation
I hereby certify under penalty of academic dishonor that the examination was administered under direct supervision without unauthorized aids, digital retrieval, or external interference, adhering to Mount Bashan School's crisis curriculum guidelines.
Section 4 — Signature & Date
Physical Proctor Signature
Date