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Test Proctor Form
Complete the following for all tests that requiring proctoring for an individual student. This form should only be filled out by Instructors.
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* Indicates required question
Student Name
*
Your answer
Course Name and Number
*
Your answer
Course Section
*
Your answer
Instructor Name
*
Your answer
Instructor Email
*
Your answer
Instructor Phone Number
*
Your answer
Exam Type
*
Computer-based
Paper-based
Test Accommodations
*
1.5x extended time
Test reader
Test in a non-distractive environment
No accommodations
Scheduled Class Time
*
Your answer
Student may begin test no earlier than:
*
Your answer
Student must end test no later than:
*
Your answer
Allowed Testing Tools:
*
3x5 Index Card
Notes
Textbook
Formula Sheet
Other
Required
If other, please explain
Your answer
Comments
Your answer
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