Outreach Exam Proctoring Checklist
Student’s Name: ___________________________________________________
Course Name: _________________________ Class Time: ________________
Instructor’s Name: __________________________________________________
Instructor’s Phone: _________________________________________________
Information Provided by:
________ Instructor _____________________ ________________
Signature Date
________ Other _____________________ ________________
Signature Date
Exam Instructions
Exam proctoring times are by appointment only. The exam proctoring checklist must accompany the exam before the exam will be administered.
__________ Time Limit
Check items that apply:
________ Notes Allowed __________ Open Book _____ Use of Computer
________ Calculator Allowed __________ Dictionary Allowed______ Scrap Paper Allowed
Special instructions: ______________________________________________________________
______________________________________________________________________________
Method of exam return: ________ Instructor will pick up _______ Return by campus mail
________ Fax to instructor _______ Return by regular mail
Return by _____________________________ if the exam is not taken.
Office Use Only
Date exam received: _______________ Date exam taken: _________________
Time exam started:_________________ Time exam finished:________________
Name of proctor: ________________________
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