Exam Instruction Form
Print Form and Fill Out
Student fills out this section:
Student Name
Faculty Name
Class
Exam Date
Exam Time
Computer?
▢ Yes
▢ No
Internet Access?
▢ Yes
▢No
Instructor fills out this section:
Date test was delivered to Learning Center
Method
▢ In Person/Courier
▢ Electronically
Date test will be retrieved in person on this date and time
Length of test time for classmates
Where or how can you be reached during the exam?
Please check items that are allowed during the exam:
▢ Textbook
▢ Notes
▢ Handouts
▢ Calculator
▢ Computer
▢ Internet
Other Instructions
Learning Center Professional Staff Member fills out this section:
Individual who recieved test
Accommodation
Time Allowed
Test Start Time
Test Completion Time
Individual who picked up test
Pickup Date
Pickup Time
Learning Center Staff Member Signature
