Correspondence Testing Request

Correspondence Testing Request

for KCC Testing Center - Riverfront Company (D218)
Student's Name:*

First NameLast Name
Student ID:*
Date*

MonthDayYear
Course (prefix/number):*
Instructor:*

First NameLast Name
College or University:*
Date needs to be completed by:*

MonthDayYear
Time length allowed:*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Please give KCC specific instructions for this exam:
Notes allowed?*

YesNo
Calculator allowed?*

YesNo
Open book?*

YesNo
Use of dictionary?*

YesNo
Breaks?*

YesNo
Use scantron sheet?*

YesNo
Answer and write directly on the test?*

YesNo
If this test is computer based, please list any websites or access codes:
Any additional instructions:
Student has been instructed a photo ID is required as well as the fee which will be applied.
OFFICE USE
Date Received:

MonthDayYear
Proctor Initials:
Log #
Test date:

MonthDayYear
Test start time:

Hour Minutes

AM/PM Option
Test stop time:

Hour Minutes

AM/PM Option
Proctor:

First NameLast Name
Test Materials Returned to:
Should be Empty:

OFFICE USE