Request for Online Test Proctoring Services
Yuba College Disabled Students Programs and Services
Marysville (530)741-6795 Sutter (530)751-5600
Email: dspsinfo@yccd.edu VP (866)274-7530 Fax 741-6942
Student Name _____________________________________
Preferred Phone ___________________________________
Course (Name & Class Code) ______________________________
Student ID# _______________________________________________
Student Email _____________________________________________
Instructor (First Initial & Last Name) _________________________________
This request has been made in accordance with federal and state laws and regulations, which govern support to
students with disabilities. This student has a specific disability that requires some modification of testing procedures.
APPROVED TESTING ACCOMMODATIONS:
Extended Examination Time: Assistive Computer Technology
1 ½ X 2 X Kurzweil 3000
Distraction-reduced environment Dragon Naturally Speaking
Other_____________________________________________
DSPS Staff Signature____________________________________________________ Date
STUDENT
By submitting this form, you agree to comply with the Yuba College Code of Student Conduct which expressly prohibits Academic
Dishonesty. Academic Dishonesty includes, but is not limited to the following:
Cheating on an examination
Receiving help from others in work to be submitted, if contrary to the rules of the course
Plagiarizing, that is the taking and passing off as one's own the ideas, writings, or work of another, without citing the sources
Submitting work from another course unless permitted by the instructor
Assisting anyone to do any of the above
DSPS Test Proctoring Policy:
A request for test proctoring must be made at least 3 working days before the scheduled exam.
All personal belongings (purses, backpacks, electronic devices, books, etc.) must be kept outside the testing room and are
inaccessible during the exam period. A storage area will be provided.
Authorized breaks are allowed in DSPS, outside the entrance, and restrooms only. No time adjustments are made for breaks.
No food or drink (except water) allowed in exam rooms unless necessary for disability-related reasons and authorized by DSPS.
Exams are proctored at the same time as the in-class exam except when other instructions are provided by the instructor.
Any changes to the day or time of each exam must be approved by the instructor.
Test proctoring rooms are monitored by video equipment.
Students arriving more than 15 minutes after their scheduled test time will forfeit lost time or must contact their instructors to
make arrangements to reschedule the test.
Student’s Signature Date
INSTRUCTOR
Please choose ONE of the following testing options:
Option 1:
Instructor will adjust for extra time for on-line at-home course exams administration through Canvas
Option 2:
Student is required to take course exams at Yuba College or other approved off campus location in a proctored
environment
Please specify: All course exams Mid term Final Other__________________________________
Regular Exam time______________ Test to be Returned via: ______________________________
Open book
Notes permitted
Calculator permitted (cover removed & held)
Dictionary permitted
Closed book
Notes NOT permitted
Calculator NOT permitted
Dictionary NOT permitted
Date
Instructor’s Signature
8-21-2017
Please mark the appropriate spaces below for proctored exams:
