EXAM PROCTORING FORM
Center for Disability Resources
Professor- Please complete and return this form to shutter@lvc.edu along with the exam. If student is permitted
the accommodation to take exams using the computer, exams must be emailed in Word format.
Student Name:
Exam Date:
Course Title:
Professor:
If a scheduling conflict arises (e.g., the student’s need for extended time overlaps into another class period or the
student has more than one exam on the same day) you would prefer:
☐ Student takes exam prior to scheduled exam period.
☐ Student completes exam any time before next class meeting.
☐ Student takes a different version of exam.
Indicate any that apply:
☐ Open Book
☐
Notes Allowed
☐ Calculator Allowed
Examination Duration:
Min. Time Allotted for others in class to complete examination (CDR uses this to calculate extended time)
Method of Exam Delivery to Center for Disability Resources:
☐ Professor sends thru campus mail (at least 1 day in advance)
☐ Professor e-mails exam to shutter@lvc.edu
☐ Professor delivers to Center for Disability Resources
Method of Exam Return to Professor:
☐ Professor will pick up at Center for Disability Resources
☐ Return via Email
☐ Return via Campus Mail
Professor’s Contact During Exam:
Other Special Instructions:
CDR-300 (rev. 8/2014)