diff --git a/openedx/core/djangoapps/agreements/migrations/0004_proctoringpiisignature.py b/openedx/core/djangoapps/agreements/migrations/0004_proctoringpiisignature.py
new file mode 100644
index 0000000000..befe64cd5a
--- /dev/null
+++ b/openedx/core/djangoapps/agreements/migrations/0004_proctoringpiisignature.py
@@ -0,0 +1,26 @@
+# Generated by Django 3.2.20 on 2023-08-03 16:09
+
+from django.conf import settings
+from django.db import migrations, models
+import django.db.models.deletion
+import opaque_keys.edx.django.models
+
+
+class Migration(migrations.Migration):
+
+    dependencies = [
+        migrations.swappable_dependency(settings.AUTH_USER_MODEL),
+        ('agreements', '0003_merge_0002_ltipiisignature_0002_ltipiitool'),
+    ]
+
+    operations = [
+        migrations.CreateModel(
+            name='ProctoringPIISignature',
+            fields=[
+                ('id', models.AutoField(auto_created=True, primary_key=True, serialize=False, verbose_name='ID')),
+                ('course_key', opaque_keys.edx.django.models.CourseKeyField(db_index=True, max_length=255)),
+                ('proctoring_provider', models.CharField(max_length=255)),
+                ('user', models.ForeignKey(on_delete=django.db.models.deletion.CASCADE, to=settings.AUTH_USER_MODEL)),
+            ],
+        ),
+    ]
diff --git a/openedx/core/djangoapps/agreements/models.py b/openedx/core/djangoapps/agreements/models.py
index f9dbf784c3..7a74d9d286 100644
--- a/openedx/core/djangoapps/agreements/models.py
+++ b/openedx/core/djangoapps/agreements/models.py
@@ -52,3 +52,15 @@ class LTIPIISignature(models.Model):
 
     class Meta:
         app_label = 'agreements'
+
+
+class ProctoringPIISignature(models.Model):
+    """
+    This model stores a user's acknowledgment to share PII via proctoring in a particular course.
+    """
+    user = models.ForeignKey(User, db_index=True, on_delete=models.CASCADE)
+    course_key = CourseKeyField(max_length=255, db_index=True)
+    proctoring_provider = models.CharField(max_length=255)
+
+    class Meta:
+        app_label = 'agreements'