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Exam Proctoring Request

Professor, please…

  • Complete the following information
  • Paper-clip this form to the sealed envelope containing all exam materials
  • Give the exam to a library staff member.  We will place the exam in a reasonably secure (but not locked) file cabinet until the exam-writer appears.
  • One of us will give out the exam to the student upon presentation of photo i.d. and will collect the exam upon completion. ( We are not able to physically oversee the exam-writer.  If you feel this is necessary, please make other arrangements.)

Library staff will seal the exam and return it directly to your mail box.

Professor: _______________________  Student: ________________________________

Exam Date: __________________ Exam Time: __________ Time Limit: ____________

 

Check all which apply: 

□  distraction-free room required         □  this is an open book exam                 

□  calculator permitted                         □  no books or supplementary materials permitted

□  use blue book provided                   □ other:__________________________________

 

Professor's signature: ___________________________  Today's Date: ______________

For library staff only:

Exam distributed by: ____________________ Date: ________________ Time: _______

 

Exam collected by: _____________________ Date: ________________ Time: _______

 

~~~~~~~~~~~~~~~~~~~Detach here~~~~~~~~~~~~~~~~~~

 For library staff only:

Professor: _______________________  Student: ________________________________

 

Exam distributed by: ____________________ Date: ________________ Time: _______

 

Exam collected by: _____________________ Date: ________________ Time: _______

□  distraction-free room required

Fill in bottom section, detach and place in completed folder.  Return main form with the exam to the professor.                                                                                       

Room Assigned:

08/2012