TESTING REQUEST FORM
FOR TESTING CENTER IN LIBRARY
Student’s Name:________________________________________ (Please print)
Current Date:______________________ Last Date to Complete Test: ___________________
Instructor’s Name:_______________________________________________ (Please print)
Course:_________________________________________________________
Accommodations Needed: _____Yes
1-2
_____No
Proctor Required: ____Yes
2
_____No
1
Students must have completed form on file each semester with testing services.
2
Please note that tests are done by general observation only unless the student makes an appointment with
testing services one week in advance for accommodations or proctoring. It is the student’s responsibility to
inform you of the date/time of appointment. The instructor is responsible for making sure the test is there at
the time of the appointment.
Student(s) may have access to the following (be specific … please):
___________________________________________________________________________
__________________________________________________________________________________________
Time Limit for exam is _______ hour(s) and __________ minutes.*
*Indicate the regular test time. Do not include extended time. Extended time for
accommodations will be noted on self-identification letter from Disability Services and will be
calculated when the test is administered.
Completed tests will be returned to the instructor’s mailbox in Faculty Support the day following
completion of the test.
Tests not completed by the Last Date to Complete Testwill be shredded at the end of
the semester.
Office Use Only:
Date Taken: ______________
Time In:
Administered by:
Time Out:
Received by:
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