PROCTOR REQUEST FORM FOR TESTING IN THE SAUK TESTING CENTER

DATE  ____________________________                                                                                                   

NAME OF STUDENT(S): __________________________________________________ 

FACULTY MEMBER’S NAME:  ______________________________________________

FACULTY MEMBER’S CONTACT PHONE NUMBER:  _____________________________

FINAL DATE FOR PROCTORING EXAM: _______________________________________

COURSE NAME: ___________________Exam Number: __________________________

INSTRUCTIONS:  _________________________________________________________

                  No time limit

                  Time limit of:  ________________

_____       No books

                  No notes

                  Open book only

                  Open notes only

                  Open book and notes

                  Use a Scantron Sheet

                  Instructional aides (calculator or __________________________________

                  Other ________________________________________________________

                  Recycle original for other students

COMPLETED EXAM(S):

                  To be placed in campus mailbox

                  To be picked up by faculty member

Send (or bring) completed form and exam(s) to the Testing Center, Room 1F2 at least 24 hours in advance of when the test needs to be administered.  Tests will be filed in your folder in our locked file cabinet until the student arrives. If you have any questions, call extension 305.  Thanks.