Proctor Request Form

Testing for Students with Accommodations Proctor Request Form

If an instructor is unable to administer an exam for a student with accommodations, please advise your student to make an appointment to take their exam a minumum of one week in advance by emailing their request to disabilityservices@park.edu

Instructors should submit the below form a minumum of 2 business days prior to the exam date.
- If there are multiple exams for a student, one form must be submitted for each exam.
- Please note this is an internal form not to be shared with students.
Testing Hours for students with accommodations

Wednesday 10:00 a.m. to 4:30 p.m. CST

Thursday 10:30 am to 8:00 p.m. CST

Please reach out to Disabilityservices@park.edu if there is a scheduling conflict and we will work with you to arrange testing.

Please note that paper exams will be scanned and emailed to the instructor. Once confirmation of receipt is received, the exam will be shredded.
Instructors: Please submit the below information on the student's behalf.
Student's Park ID#*
Information entered by instructor
Student's Name*

First NameLast Name
Course number*
Instructor's Name*

PrefixFirst NameLast Name
Instructor's Contact Number*

Area CodePhone Number
Instructor's Park E-mail*
All exams will be emailed back to the instructor to the Park-Email address provided above.
Exam instructions

Instructor please fill out all the information below
TIME ALLOWED FOR THE TEST: This time should reflect the original time allowed for all students to take the exam. Learner Access and Disability Services will adjust according to accommodations approved if needed*
Ex. 30 min, 45 min, 1 hour, etc.
If the student reaches the time limit and still has questions left, do you want to allow EXTRA time to finish the exam?*

YesNo
If yes, how much EXTRA time do you allow?*
Ex. 10 min, 30 min, 45 min
Calculator allowed*
Open book*
Open notes*
Is this a computer based test or a paper test? *
Is the student taking the exam through canvas? *
Enter password for canvas*
Are there additional instructions for the exam? Answer N/A if there are none*
Upload a copy of the exam. If there are multiple exams please complete one form per exam*

Browse Files

Cancelof
Should be Empty:

Instructors: Please submit the below information on the student's behalf.

Exam instructions