Academic Testing Center
INSTRUCTOR FORM
Please complete all fields; incomplete forms will not be processed.
Submit completed forms to testingcenter@hagerstowncc.edu.
Instructor Name: ________________________________ Emergency phone number*: _____________________
*to be used only when information from instructor is required
Course prefix, number & section (e.g., MAT 109-02): _______________ Type of course:
Test Title (e.g., test #2, midterm, etc.): ___________________________ Time limit: _________________________
Number of students:
If 4 or fewer students, please list names: ___________________________________________________________________
Roster attached? Yes No
Test start date: ___________ Test end date: ___________ Deadline extensions:
Permissible Items (check all that apply): book ___ notes __ scratch paper _
calculator: graphing __ non-graphing
Other/Restrictions: ____________________________________
Test answers: Password: _______________
Other (please specify): _____________________________________
Special instructions/ADA accommodations approved by HCC Disabilities Services:
Note: All paper-based exams must be submitted in
person (preferred) or via interoffice mail.
All paper-bas
ed exams mus
t include instructor’s
name on the front page f
or
test security purposes.
Phone: 240-500-2398
E-mail: testingcenter@hagerstowncc.edu
