Proctor Form--Hutchinson
Exam proctoring times are by appointment only. The Exam Proctoring Form must accompany the exam before the exam will be administered.
STUDENT’S NAME______________________________________________________________
COURSE NAME ___________________________________ CLASS PERIOD______________
INSTRUCTOR’S NAME___________________________________________________________
INSTRUCTOR’S PHONE_______________________________
INFORMATION PROVIDED BY:
_____ INSTRUCTOR _____________________ _____________________
Signature Date
____OTHER _____________________ _____________________
Signature Date
Exam Instructions
Check items that apply
Maximum time allowed: _________________
____Notes Allowed ____Open Book ____Use of Computer
____Calculator Allowed ____Dictionary Allowed ____Scrap Paper Allowed
Special Instructions_____________________________________________________________________
______________________________________________________________________________
Method of exam return:
_____ Instructor/Faculty Secretary will pick up
_____ Return by campus mail
Exam must be taken by: _______ AM/PM on ______________
******************Guidance Office Use Only*******************
Date exam received________________ Date exam taken______________________
Time exam started_________________ Time exam finished____________________
Proctor__________________________
Please print on Blue paper only!