ADC - Testing Center | Test Proctor Request Form

Fields with * are required.

Testing Location:

* Mark all centers that will need to administer this exam:






Instructor Information:

* Instructor's Name:
* Phone:
* Email:

Course Information:

* Course Name:
Please complete either "For CSI Courses" or "For Non-CSI Courses".

For CSI Courses

Course Number:
Course Section(s):

For Non-CSI Courses

Institution Name:

Student Information:

Please complete either "For an Entire Class" or "For an Individual".

For an Entire Class

How many to test:

For an Individual

If you have additional student names but not an entire class please enter additional names in instructions box below.
Student's First Name:
Student's Last Name:

Test Administration Information:

Please Note: The testing center does not administer open-book or reference material exams. We also cannot time exams for multiple students. Each instructor is responsible for supplying the copies of their exam. The instructor’s name and course information are required on the exam.

* Name of Test:
* Open Date:

(mm/dd/yyyy)
* Close Date:

(mm/dd/yyyy)
* Approximate time to complete test:

Exam Information:

* Computer Access?
   
If "Yes" for computer access, please specify website URL or program used.
Password:
* Student may write on test?
   
* Scantron/Answer Sheet?
   
* Scratch paper? (2 sheets at a time):
   
If you select "Yes" for scratch paper, would you like it:
    at Testing Center
*Notes? (1 page maximum):
   
If you select "Yes" for notes, please specify the size:
* Are students allowed to use calculator?:
   
If you select "Yes" for calculator, type of calculator allowed:
   
Would you like the calculator cleared before the exam?
   
Other Instructions?:

Completed Exam Information:

Complete Proctor Supervision Form/Information? (Non CSI exams only)
   
Return Exam: