DISABILITY SERVICES
EXAM PROCTORING CHECKLIST
TO BE COMPLETED 3 DAYS PRIOR TO EXAM

Student                                                         Program                                   
Course                                                          Date                                           
Instructor                                                      Exam Time                                

Exam Location                                                                                             

Time Allowed:         Double Class Time                                 Other (Specify)                       

Check items that apply:
          Test reader                                              Test writer
           Notes allowed                                         Open book
           No notes allowed                                    Closed book
           Calculator allowed                                   Scrap paper allowed
           No calculator allowed                              Scrap paper to be returned

Special Instructions:                                                                                                                       
                                                                                                                       

Method of Exam Delivery:                                        Method of Exam Return:
        Instructor will deliver to test site                                                      Instructor picks up at test
          Student picks up from Instructor                                                     Student returns to Instructor

                                                                                                                                                                       
                                                    (Instructor Signature & Date)

                                                                                                                                                                       
                                                    (Proctor Signature & Date)

***Disability Services will not be responsible for pickup or delivery of exams.***