UpdatedAug2018
GTCCAssessmentCenter
TestingInstructionForm
Instructor/CourseInformation
Instructor’sName: DateSubmitted:
OfficePhone/AfterHoursNumber: / (Willnotbeshared)
Individual’sName(ifapplicableorisRosterattached):
CourseName: CourseNumber:
TestName: ChaptersCovered:
Firstday/timetestmaybetaken: Lastday/timeoftest
TestInformation
ShouldthestudentWRITEonthetest?
☐ Yes No Moodle
IsthetestTIMED? Yes No LENGTH of test
Iftesttimelimitexceeds1hour,arestudentsallowedarestroombreak?
☐ Yes ☐No
IsthetestOPENBOOK?
☐ Yes No
AreNOTESallowed?
Yes No
(Ifyes,specifytype;ex43X5cards;1sheet8.5X11bothsides)
☐ Yes ☐No ☐N/A
☐ Yes ☐No ☐N/A(Ifso,password)
AreCALCULATORSallowed?
IsthetestPASSWORDprotected?
ArethereDISABILITYACCOMMODATIONS? ☐
Yes ☐No(Ifyes,pleaseexplainbelow)
OtherInformationorDisabilityAccommodations
Pleasenotethatentireclassescannotbeseatedatthesametime,duetotestingspaceavailabilityandtheintegrityofthe
testingprocess.Ifyouhaveanyquestionsregardingourtestingpoliciesasiteffectsfacultytesting,pleasevisitourwebpages
ontheGTCCWebsite.Ifyouwouldliketospeakwitha testproctor,pleasedial336‐334‐4822andenterext.50574or
50017(JTN),50364(HP),50335(GSO).
☐ ExtendedTime ☐ DistractionReduced/SeparateRoom☐ VoiceOutput
Other