Montgomery College Assessment Center/Takoma Park
Academic Test Request Form (TRF)
Professor's Name MC Tel.No./Ext.
Last First
Day/Evening No.
Name and ID Number of Authorized Students:
Course No. ►List students' names and ID numbers or attach a clean roster.
►Indicate students requiring double time with an asterisk.
Test Name
Last Name First Name MC ID# Test Faculty's
Taken Initials
Begin Date End Date 1.
Number of Tests Submitted 2.
Time Allowed: Hours Minutes 3.
Please indicate if this is a
DL COURSE
DSS STUDENT(S)
4.
Student(s) may record answers on: 5.
Test Copy 6.
Scantron (A.C. Issued) 7.
Printout 8.
Ruled Paper (A.C. Issued) 9.
Other Specify 10.
Special Instructions/Accommodations:
Calculator: (If detailed instructions are required, please provide a written copy for each student.)
Basic Graphing Programmable
Dictionary:
English Foreign Language
Scratch Paper (A.C. Issued)
Textbook/Ref. Book Specify
3x5 Cards
Please do not write below this line.
For use by Assessment Center staff only.
Staff's
Notes Specify
initials
Computer/Software Specify
Other Aids Specify
For use by Assessment Center staff only.
Drop Box Yes No
Test Received by Date Time
Data Entered by Date Time
Revisions by Date Time
Revisions by Date Time
Revisions by Date Time
Professor's Signature
Staff's Initials Date Time (Required for final transaction only.)
BLENDED
COURSE
