This request must accompany test materials.
Testing center does not administer proﬁciency exams or accept/distribute homework.
Accommodation requested ❑ Extended time ❑ Scribe ❑ None ❑ Test reader:
If accommodations are requested, please deliver the test to the center 3 days in advance to prepare for audio and
PLEASE PRINT LEGIBLY.
PHOTO ID AND STUDENT ID REQUIRED FOR TESTING.
Student name: Course no.:
LAST FIRST MIDDLE (FULL)
Student ID (7 digits): Date: / /
Instructor: Alternate email (optional):
Deliver to: ❑ L355 Or ❑ W102
Please give the test proctor speciﬁc instructions for this ❑ exam ❑ quiz
Needs to be completed by:
Length of time allowed in classroom:
Extended time on exams: Y N Amount: ❑ 50% ❑ Double ❑ Other
Notes allowed Y N Breaks Y N
Calculator allowed Y N Use Scantron sheet Y N
Open Book Y N Answers directly on test Y N
Use of dictionary Y N May write on test Y N
• Is this test delivered through the Online Learning Management System?
❏ Yes ❏ No
• I have veriﬁed online settings for this test’s availability to the student(s)(Published, Available From
and Until dates, attempts remaining): ❏ Yes
• Should the test not be available due to an online setting, I consent to online help staff modifying
the settings as necessary to allow access*:
• Password (access code) for online test (if one was used): _____________________________
• If online help staff modiﬁes a setting in your course, it will be documented and you will be contacted.
Details on above checklist or additional instructions:
OFFICE USE: Expired returned on: / /
Date taken: / / Proctor: Seated at: _______________
Test start time: Maximum end time: Actual end time:
Completed email sent date: / / Proctor:
*Expired test may not be graded by instructor.
____________________________________ Date: _____________________
Student advised testing center closes at: Initials: _______
____________________________________________ Date: ______________________
Kankakee Community College
Make-up Testing Request for KCC Testing Center
OFFICE USE: Received: / / Proctor initials: _______ Log # ______________
This form must be completed using Adobe Reader. If needed, download a free copy: https://get.adobe.com/reader/