University of Illinois at Chicago Disability Resource Center Exam Proctoring Form

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Student Name:
ID#:
Instructor Name:
Course:
Office Address:
M/C
Phone Number:
Instructor E-mail(mandatory):

SCHEDULE OF TESTS TO BE TAKEN AT THE DISABILITY RESOURCE CENTER

Test #	Test Date	Standard Test Time
1	Date	Time
2	Date	Time
3	Date	Time
4	Date	Time
5	Date	Time
6	Date	Time
Final	Date	Time

Student must take test at same day and time as class.	Yes
Class meets at (time) : on (day of class)
Student may take test at any time the same day.	Yes
Student may take test on another day per instructor and DRC approval and arrangement.	Yes
INSTRUCTIONS (Please check all that apply)
Textbook ?	Open Closed
Notes allowed?	Yes No
Blue test booklet/scratch paper ok ?	Yes No
Scantron needed?	Yes No
Dictionary?	Yes No
Calculator?	Yes No
Return all test materials?	Yes No
Is someone available by phone for questions?	Yes No If Yes, phone number
EXAMS will not be administered without this form
Completed Exam Return (Please Check One)
Instructor will pick up exam at Disability Resource Center (1190 SSB)?	Yes No
Instructor requests completed exam be faxed to:	Yes to fax number:
Instructor request completed exam sent via campus mail?	Yes No
Questions/Comments:
You will need to sign a form when the exam is delivered or picked up. Signature will need to be of the instructor designee receiving completed exam from the DRC.	Press Submit to send to DRC.