Faculty Exam Request Form
Instructor's Name
*
First Name
Last Name
Instructor's GFCMSU Email
*
example@example.com
Instructor's Office Phone Number
*
-
Area Code
Phone Number
Instructor's Mobile Phone Number
-
Area Code
Phone Number
Course Name & Number
*
Exam Title
*
Type of Exam
*
Online via MyMathLab
Online via Canvas
Online via
Paper exam
Items to be Used During Exam
Scratch Paper
Calculator - Select calculator type below
Notes
Textbook
Scantron Form
Other (please complete special instructions)
Calculator Type
Basic 4 Function
TI-30
TI-83
TI-84
Exam password for computer-based tests
This password is used by the proctor to log students into this specific exam. If no password is required, please indicate this.
Exam Period Start Date/Time
*
-
Month
-
Day
Year
Date
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
Exam Period End Date/Time
-
Month
-
Day
Year
Date
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
Exam Time Length
*
Please indicate the regular length of time students have to complete this specific exam (i.e. 50 minutes, 75 minutes, etc.)
Special Instructions
Please list the student name(s)
Please verify that you are human
*
Submit
Should be Empty: