Office Use Only
Exam Rec’d_____ Emailed_____
Calendar_____
Board_____
Start_________ End__________
Submit Form:
3 working days prior to exam date
5 working days prior during
Mid-Term & Final Exam Weeks
NO Campus Mail
ODS TEST PROCTORING REQUEST FORM
Student Information:
Student’s Name
Instructor’s Name
Instructor’s Phone
Teaching
Assistant’s Name
Number & Section
(ex. 1001-101)
Course Subject
(ex. BIOL)
Regular Class period allowed for exam
50 min.
1 hr & 15min.
2 hour final
Exam Date you and the student have agreed on: **
Exam Time you and the student have agreed on:
APPROVED ACCOMMODATIONS:
Extended time:
1.5X
2X
SEPARATE ROOM
READER
COMPUTER FOR TYPING
*SCRIBE
ITEMS Allowed during exam:
Paper
Open Book/Notes
Other (please list)
Computer
NON-programmable
Programmable
Calculator
Calculator
Formula sheet

How Will ODS Receive the Exam? (Exam must be received at least 24 hours before scheduled start time)
Faculty member or authorized personnel will deliver the exam to our Office (707 Building, Room 503).
Exam will be emailed to odstesting@marquette.edu. (This is the ONLY secure email for exams)
Exam will be faxed to the Office of Disability Services @ 414-288-5799.
Student will deliver the exam in a sealed confidential envelope to the Office of Disability Services (707 Building, Room 503).
How Do You Want the Exam Back?
Faculty member or authorized personnel will pick up the exam from our Office (707 Building, Room 503).
Student returns, in a sealed envelope, to the department mailbox in Building & Room ______________________
Professor Signature
Date
** Remember, you can list all exam dates for the semester as long as you have discussed the dates and times
with the student.
Incomplete Forms will be rejected and NOT processed.
Office of Disability Services Marquette University P.O. Box 1881 Milwaukee, WI 53201
Phone: 414-288-1645 Fax: 414-288-5799 ODS 07/2015