This form must be completed for EACH exam to be proctored in the Student Exam Center.
Instructor's Name *
Instructor Email *
Instructor Phone Number *
If you choose you may also include your cell phone number
Class Number *
Ex. Math 102
Class Days/Times *
EX. MWF 10:00 or Internet
Name of Test *
Ex. Chap 1 Quiz
Dates students may take the exam. *
Ex. 2/2/19 - 2/5/19
Maximum time allowed *
Test Format *
Password *
If the test is computer based, what is the password? If students have individual passwords place the password next to the student name in the the next field. If paper / pencil exam state n/a
Student Names *
List alphabetically, include individual passwords if applicable.
Will the exam require a Scantron? *
Calculator Usage? *
What other materials are allowed? *
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