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Exam Proctoring Request Form
Instructor Name
First Name
Last Name
Email
Student Name
First Name
Last Name
Course Information
Course Title
Course I.D.
Course Number
 
Exam Information
Exam Date
Ex. 01/01/07
Exam Time
Ex. 9:00am
Exam Location
 
Exam Title
Exam Type
In what format will the test be provided?
Paper
Disk
Online
Materials Allowed
Calculator
Notes
Book
Spellchecker
Other Materials
Have you spoken with anyone from the Student Success Center?
Yes
No
If yes, can you please provide their name?
Please use the space below for testing directions
or any additional comments.
Instructors must bring a copy of the exam with test directions to Brennan 57B or email the exam with directions to coleman@hnu.edu. The completed exam can be retrieved by the instructor from Brennan 57B. If you have any other questions please call the Student Success Center ext. 1356.

Forms must be submitted 48 hours prior to the desired test date. All late or incomplete froms will not be processed and the exam will not be administered.