Testing Proctor Request Form

Testing Proctor Request
Are you a Howard College instructor?

YesNo
Sites Requested? (Where do you need the exam proctored?)

Big SpringLamesaSan AngeloSWCD
Instructor Name
Your Name
Email
Your Email
Instructor Phone
Your phone or a number where you could be reached during the exam if needed
Course
Example: BIOL1309.009
Number of Students
Expected number of students to test
Test Name
Example: Bio II NM Lecture Exam Midterm
Student Names List
You can copy/paste or type the student names here. Or if you prefer, you can upload a separate document with that information. Word, Excel, or PDF files are all acceptable.
Names List Upload

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Cancelof
Do you have students needing ADA accommodations during the exam?

NoYes (If you select 'Yes' details and options will be available to select at the end of this form.

Special Accommodations

Students with approved ADA accommodations are required to schedule an appointment a full week in advance. Instructors are required to forward a copy of the Approved ADA Accommodation letter to the Test Center before the student can test to enable the Test Center to properly arrange for the approved accommodation(s). For questions regarding accommodations contact the ADA Coordinator.
Accommodation Request

Quiet EnvironmentReading AloudExtended TimeBraille TranslationExtra BreaksOther
Special Accommodation Notes
Please add any notes or comments regarding the special accommodations.

Instructions for Test Administration

Please include the specific details we need to properly administer the exam.
Open Date

MonthDay Year
First date exam is offered
Close Date

MonthDay Year
Last date exam is offered
Time Allowed
How long (in minutes) is allowed for the exam?
Are Breaks Allowed?
Enter Yes or No. If Yes, please include a description. Example: 1 break of 10 min. permitted
Are restroom breaks allowed?
Enter Yes or No
Online Access Information
Required software
Example: Blackboard
Exam Password
Resources Allowed
Calculator?
Please enter Yes or No. If Yes, enter a description. Example: Yes, a scientific calculator is allowed.
Notes?
Please enter Yes or No. If Yes, enter a description. Example: Yes, single page, front only, hand written.
Textbook?
Please enter Yes or No. If Yes, enter the textbook name. Example: Yes, Textbook ISBN # or Title & Author
Scratch Paper?
Please enter Yes or No. If Yes, enter a description. Example: Yes, student can keep (or we collect and destroy after exam).
Additional Information?
Is there any additional information we may need to proctor the exam?
Should be Empty:

Testing Proctor Request

Special Accommodations

Instructions for Test Administration

Online Access Information

Resources Allowed