Fillable MAKE-UP TEST AUTHROIZATION FORM Success Center (A Building) (Northwest State Community College)

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MAKE-UP TEST AUTHROIZATION FORM Success Center (A Building) (Northwest State Community College)

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MAKE-UP TEST AUTHROIZATION FORM
Success Center (A Building)
Faculty – COMPLETE TOP HALF OF THE FORM, ATTACH TO A MANILA ENVELOPE, AND RETURN TO THE
SUCCESS CENTER. COMPLETE THE BOTTOM HALF (INCLUDING SIGNATURE) AND GIVE TO THE STUDENT.
STUDENT WILL BE REQUIRED TO PROVIDE ID FOR TESTING.
Date: Student’s Name: Instructor Name: Course #:
__________________________________________________________________________________________
Time Limit (must check one): Permissible Materials (check all that apply):
_____ 1 hour _____ Open book
_____ 1 hour 30 minutes _____ Open notes
_____ 2 hours _____ Calculator
_____ Unlimited _____ Formula Sheet/Memory Jogger
_____ Other (specify) ____________ _____ Other (specify) ____________
_____ NO MATERIALS
Date test must be completed by: ____________ _____ Accommodations (ADA)
_____ ParTest
SUCCESS CENTER USE ONLY:
Date Received: _____ Completed _____ Date Returned: _____
Logged by: _____ Not Completed _____ Initials: _____
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
SUCCESS CENTER MAKEUP TESTING STUDENT INFORMATION
This is your “ticket” to take your test! BRING THIS TICKET AND A PHOTO ID TO SUCCESS CENTER
Fall/Spring Semester Testing Hours: Appointments not necessary unless
Monday – Thursday 8:30 am – 5:30 pm otherwise specified. To make an
Friday 8:30 am – 1:00 pm appointment, call 419-267-1447 or
Summer Semester Testing Hours: email success@northweststate.edu.
Monday – Thursday 8:00 am – 4:00 pm
If you cannot test during these times, please call the Success Center Coordinator at 419-267-1457.
Date: Student’s Name: Instructor Name: Course #:
__________________________________________________________________________________________
Time Limit (must check one): Permissible Materials (check all that apply):
_____ 1 hour _____ Open book
_____ 1 hour 30 minutes _____ Open notes
_____ 2 hours _____ Calculator
_____ Unlimited _____ Formula Sheet/Memory Jogger
_____ Other (specify) ____________ _____ Other (specify) ____________
_____ NO MATERIALS
Date test must be completed by: ____________ Instructor Signature:_________________________________
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MAKE-UP TEST AUTHROIZATION FORM Success Center (A Building) (Northwest State Community College)

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Completed 3 October 2020

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