Examination Incident Report
Complete this document in its entirety to report any irregularities you experienced during the administration
of the examination. You have five days from the time of the examination to submit this document. If it is
submitted after five days, you will not be able to appeal your examination score results. Submit this
document by emailing it to cpce@cce-global.org.
Examination: _____________
Date: ________________
Please identify the reason for the report and include a description of what took place, who was
involved, where, what time, how the issue was addressed, etc.
Description of Irregularity (Please select the reason for your submission below.)
Specific complaint regarding lack of special examination accommodation
Physical environment (electrical outage, Internet disruption, etc.)
Administration error (improper test instruction, improper timekeeping,etc.)
Other:
Please use the space below to describe in detail the irregularities that took place during
the examination.
TO BE COMPLETED BY EXAMINEE
Name: Email: Telephone:
My
signature below is verification that I experienced the events described in this document.
Examinee Signature: University: Date:
___________________
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___________________
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Site: Web Based Version
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