Sheila Hamilton Student Success Center Extended Time Faculty Cover Sheet
Please return for each exam
Section 1: Student and Course Information
Student Name and Course/Section Number
Student 1:
Student 2:
Student 3:
Student 4:
Student 5:
Instructor Name and Contact Information (during exam):
APPROVED Day/Time of Exam:
Exam-time typically allowed for class (please do not include extra time):
Section 2: Online Exam Information
I pre-programmed extended time in the online exam software ( ): Password ( )
Section 3: Student Material Allowed-Please Check All That Apply
Open Book
Open Notes
Scrap Paper
Word Processor
Formula Card (Select )
Calculator (Select )
Other ( )
Section 4: Additional Instructions for Proctor
Section 5: Completed Exam Return
Scan and email to my SHU email: Specify if not SHU email address
I will pick up the exam from the Testing Center in the Sheila Hamilton Student Success Center
Please deliver to my SHU office (note-delivery may have up to a 48-hour delay)
Department/Office Number:
Questions? Contact the Testing Center: or 203-396-8363
Select or Type
Select or Type