Exam Proctoring Form

Exam Proctoring Form UIC - Disability Resource Center
1200 West Harrison, 1190 SSB (M/C 321) Phone (312) 413-5051 Fax (312) 413-7781
Upon receiving your Exam Proctoring Form, we will contact you to verify your information and complete the process. For more information go to the following page: Exam Proctoring Guidelines
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 # (specify type of text, i.e. quiz, midterm, exam, etc.)	Test Date	Amount of Time Class is Allotted for Test (hours)
1	Date	Alotted time
2	Date	Alotted time
3	Date	Alotted time
4	Date	Alotted time
5	Date	Alotted time
6	Date	Alotted time
Final	Date	Alotted 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
Scratch paper ok ?	Yes No
Scantron (bubble sheet) needed?	Yes No
Dictionary ok ?	Yes No
Calculator ok ?	Yes No
Return all test materials (including scratch paper)?	Yes No
Is someone available by phone, if student has a question?	Yes No If Yes, phone number
Completed Exam Return
Instructor will pick up exam at DRC?	Yes No
Instructor requests completed exam be faxed to:	Yes to fax number:
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.

Exam Proctoring Form

UIC - Disability Resource Center