Test Proctoring Request Form
Directions: Please fill out and check off the appropriate information below:
Faculty Information
Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email Address
*
Course Information
Math Course
*
Please Select
Math 34A
Math 38
Math 46
Math 96
Math 104
Math 107
Math 116
Math 119
Math 121
Math 122
Math 141
Math 150
Math 151
Math 210A
Math 245
Math 252
Math 254
Math 255
Math 15A
Math 15B
Math 15C
Math 15E
Math 15F
Class Number (formerly known as CRN)
*
Class Meets
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
05
10
15
20
25
30
35
40
45
50
55
Minutes
AM
PM
AM/PM Option
Student Information
Student's Name
*
First Name
Last Name
CSID Number
*
(10 digits)
Must start test by
*
-
Month
-
Day
Year
Date Picker Icon
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Test Information
Name of Test
*
Number of Pages
*
Scantron Required?
*
Yes
No
Length of Test
*
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
:
Hour
00
05
10
15
20
25
30
35
40
45
50
55
Minutes
Upon Completion of Exam
*
Completed test placed in instructor's mailbox
Instructor will pick up test from the Math Center
Accommodations
Please check the following that the student will be allowed to have during the exam
*
Textbook
Notes
Scientific Calculator
Graphing Calculator
None
Special Instructions:
Upload your test file (Formats: doc, docx, pdf, zip)
Warning: Max file size is 3MB
Enter the message as it's shown
*
Submit
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