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Exam proctoring Authorization form

This form must be completed, signed, and delivered to exam site before exams will be administered. It is the responsibility of the student to schedule exams with DSS at least one week prior to the test date. Testing outside the classroom or academic department is warranted only if circumstances prevent instructor from making localized arrangements or if student needs assistive technology at DSS. Failure to schedule an exam one week in advance may lead to DSS denying a specific time and date for the exam. If the student is caught cheating, the professor will be notified, and testing accommodations may be revoked. DSS staff will email the instructor if an exam is not retrieved by the end of the semester in which it was taken.  An exam left in DSS after such notification will be filed in the respective student’s file.

 

PLEASE PRINT CLEARLY :

Student’s Name: _______________________________________________
Course Name and Number: ______________________________________

Exam Date: _________ Exam Time: _________Exam Location: ________

Student Signature: ________________________ Date: _______________

Please initial all pertinent rules and mark through those rules that do not apply (to be filled out by the instructor)

_____ Book(s) may be used:

Title:___________________________________________________________

_____ Notes may be used

_____ Dictionary may be used

_____ Calculator may be used

_____ Scratch paper may be used

_____ Student may keep test questions

_____ Student may keep scratch paper

_____ Other – Please Explain:

______________________________________________________________

Time allotted for the class to take the test: ____

 

Instructor’s Name: ______________________________________________

Instructor’s Signature: ___________________________________________

Office Address: _________________________________________________

Instructor’s Phone: ______________________________________________

Departmental Phone: ____________________________________________

Date: _________________________________________________________

I will pick up the test on ____________________ at ___________________

 

(Office Use Only)

Date Exam Received: _____________ Staff Initials: ______

Date Exam Administered: __________ Time Started: ______

Ended: ______ Staff Initials: _________  

Assistive Technology:______________________________

Comments: _______________________________________________________________

Pick up: ________________________________________________

Instructor/Staff Signature Date

I decline the recommended accommodations for this exam and waive the right to use these accommodations.
Student’s Signature: _________________________________________ Date: _________

09/10

 

Directions for Accessing Exam Accommodations

Disability Support Services (DSS) offers exam accommodations for students with disabilities such as extended time, alternative formats, and assistive technology depending on the student’s disability.  These accommodations are implemented to give students with disabilities equal access to testing and accommodates for certain limitations related to the student’s disability.

Testing outside the classroom or academic department is warranted only if circumstances prevent the instructor from making localized arrangements or if student needs assistive technology at DSS.  Therefore, when testing accommodations or alternative testing is needed, students are responsible for discussing this issue with the professor to make the appropriate arrangements to have the exam administered.  It is the responsibility of the student to schedule exams with DSS at least one week prior to the exam date.  Failure to schedule an exam one week in advance may lead to DSS denying the requested time and date for the exam.  DSS will make every effort to accommodate students in a timely and reasonable manner.

Standard testing procedures for DSS:

1. Students must fill out an exam proctoring authorization form in order to notify DSS about their needs for alternative testing and accommodations. 
2. This form must be completed, signed, and delivered to DSS by the student before exams will be administered. The student’s name, exam date, time of the exam, and the course name and number should be specified on the form. Instructor should indicate on the form any materials that the student can use during the exam and any directions that the student should be made aware of to take the exam.
3. Students should submit an exam authorization form to DSS at least one week prior to the examination date and request professors to make arrangements to have the exam sent to DSS. 
4. Professors may arrange to have the exam sent to DSS by having the exam delivered to DSS, emailing the exam as an attachment, faxing the exam, or having the student pick up the exam in a sealed and signed envelop prior to testing. 
5. DSS will proctor the examination on the date and time indicated on the authorization form while providing the recommended accommodations needed by the student. With the exception of evening classes, students should take the test the SAME TIME the class regularly meets unless the instructor provides permission for an alternate time. DSS is authorized to proctor the exam only during the time specified by the professor on the testing authorization form. 
6. The instructor should specify the date and time he or she will pick up the exam at DSS on the exam authorization form.  DSS staff will email the instructor if an exam is not retrieved by the end of the semester in which it was taken.  An exam left in DSS after such notification will be filed in the respective student’s file.  

Students who arrive at DSS late for an exam may have this time deducted from their scheduled testing time, as in the case of classroom testing.  If a student does not come in to take a scheduled exam at DSS, the examination will be sent back to the professor.  Therefore, students must have the professor approve any change in time of administration of exams before DSS will make an appointment to reschedule proctoring the exam again.

Thank you for your assistance in this testing process!

09/10

 

Updated: Wednseday, December 1, 2010

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