Proctored Test Request Form
Exam Clarification (ex. Unit 1 Exam) Please note if a different version from the original test.
Materials Allowed
Email or Mailing Address
2019 Kellogg Community College
Proctored Testing Request Form
Name of Institution
Name of Institution
Contact Person
Contact Person
Phone Number
Contact Phone Number
Course Name, Section Number and Instructor Name (ex. HUSE 101-01-Reve)
Course Information
Exam Clarification
Student Name
Student Name
Test Type
Paper-Pencil
Computer
Selection
Time Limit
Time Limit
None
Textbook
Scratch Paper
Calculator
Ti Inspired CAS
Ti30 xa
Ti 503 sv
Ti 84
Selection
Dictionary
Other
Note Card
If you checked Other Materials Allowed, please indicate here what other materials are allowed.
Other Materials Allowed
Deadline Date (this is the date the work order will be closed and is required)
Email Address
Attach
Detach
Attach
Detach
Attach
Detach
Attach test and any other forms needed for testing.
TEST MUST BE SUBMITTED AT LEAST 24 HOURS PRIOR TO ADMINISTRATION
Submit
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