Exam Instruction Form

Print Form and Fill OutPrint

Student fills out this section:


Student Name


Faculty Name




Exam Date


Exam Time

▢ Yes
▢ No

Internet Access?
▢ Yes



Instructor fills out this section:


Date test was delivered to Learning Center


▢ 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




Time Allowed


Test Start Time


Test Completion Time


Individual who picked up test


Pickup Date


Pickup Time


Learning Center Staff Member Signature