TESTING CENTER COVER SHEET
www.csmd.edu/StudentSuccess/TestingCenter
Administer at: LAPL □ LEON □ PRIN □ Remote Site □ Course Name _____________________ Course # _ _ _ -_ _ _ _
Pickup at: LAPL □ LEON □ PRIN □ Section #__________________ Exam/Quiz # ___________
Instructor’s Name:_______________________________________ Signature: __________________________________
Contact Info: ________________________________________
Test For: Group: □
Roster Enclosed: Yes □
No □
Type: Classroom Make-Up □
WHOLE CLASSROOM TESTS WILL NOT BE ACCEPTED. TIMING OF TESTS IS VERY CRITICAL. PLEASE BE VERY
SPECIFIC ABOUT TIMING AND CONSIDERATE OF TESTING CENTER HOURS.
Allow 2 days for delivery to another campus. Tests ending on Friday to be sent to another campus will not be in the
mail until Monday. THERE IS NO SATURDAY MAIL SERVICE.
Student’s Name(s) (if no roster):
2. 5.
3. 6.
Students must complete this test by: Date & Time _________________________and within_____
Hours ______
Minutes
Instructor will pick up the test from the Testing Center by: Date & Time _______________________@ LAPL/PRIN/LEON
Student(s) may use only the materials indicated (Mark all that apply):
□ Pen □ Bluebooks # □ Scantron #
□ Pencil □ Charts # □ Calculator/type
□ Scratch paper □ Tables # □ Formula sheets #
□ Notes: # Specifications Password:
□ E-Books, Textbooks, or Reference book(s) title(s)
Additional Instructions:
ADA ACCOMMODATIONS: When turning in multiple tests, please fill out a separate form for each student with
accommodations. Only granted accommodations are to be given.
ADA EXTENSIONS: LA PLATA, EXT. 7614 LEONARDTOWN, EXT. 5420 PRINCE FREDERICK, EXT. 6009
Student’s Name: ______________________________ Proctor/Scribe’s Name: __________________________________
Extended time: _____ Hours _____ Minutes This Represents: Time and a half □ Double Time □
Assistive Technology: Word q3 □ Dragon □ Kurzweil □ Other □ ______________________________________
Date Test Received: ____________________________
Received by (Testing Center Staff Initials): __________
Test picked up by (signature): ___________________________
Date: _______________________________________________
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