OFFICE USE ONLY
NVCC Annandale - Testing Center
SERVICES REQUEST FORM
PLEASE NOTE: This form must be filled out COMPLETELY and ACCURATELY by the instructor. We DO NOT proctor faculty referred exams during
the scheduled final exam week, except for Students with Accommodations (SWA) See reverse side of this document for policies for Faculty Exams.
INSTRUCTOR NAME:
DATE TESTS RECEIVED
NUMBER
FORM REVISED 02/2014
ENTER INSTRUCTOR NAME
BEST CONTACT NUMBER:
SUBJECT/COURSE #:
BEST CONTACT NUMBER
EMAIL ADDRESS:
EXAM TITLE:
SUBJECT/COURSE NUMBER
LAST DATE FOR EXAM TO BE GIVEN:
YOUR COLLEGE EMAIL ADDRESS
EXAM TITLE
THE LAST DAY FOR THE STUDENT TO TAKE EXAM
PLEASE CHECK ONE OF THE FOLLOWING BOXES FOR EACH OPTION:
YES
NO
CONDITION
SPECIAL INSTRUCTIONS:
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☐
Open Book
☐
☐
Open Notes
ANY SPECIAL INSTRUCTIONS MAY BE TYPED IN THIS SPACE, TO INCLUDE:
Calculator Type, Permission for Dictionary, Word Processor, Web Access, PC
Application Access, Specific Start and End times for exams. PLEASE BE SPECIFIC.
☐
☐
☐
☐
☐
☐
☐
☐
CALCULATOR
Please Specify Type 
SCANTRON
Provided by Testing Center
BLUE BOOK
Provided by Instructor
OTHER:
(Dictionary, PC Access, etc)
Time Limit :
HOURS HOURS MINUTES MINTUES
(REQUIRED)
ALL FACULTY REFERRED EXAMS MUST BE STARTED NO LATER THAN 90 MINUTES PRIOR TO CLOSE.
ALL TESTS ARE STOPPED, COLLECTED, AND/OR SUBMITTED 15 MINS PRIOR TO CLOSE.
STUDENT NAME
(FIRST AND LAST NAME REQUIRED)
SWA
1 Enter a Student’s Name Here
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2 Enter a Student’s Name Here
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3 Enter a Student’s Name Here
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4 Enter a Student’s Name Here
☐
5 Enter a Student’s Name Here
☐
6 Enter a Student’s Name Here
☐
7 Enter a Student’s Name Here
☐
8 Enter a Student’s Name Here
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COMPLETED EXAMS WILL BE:

☐Picked Up
☐
Delivered via
Campus Mail
{
TESTING CENTER STAFF ONLY
DATE TAKEN
PICKED UP / MAILED
☐
Bus & PS
☐ Continuing Ed.
☐
Health Tech
☐ Lang. & Lit.
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Liberal Arts
☐ M, S, & E
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OTHER : IF OTHER PLEASE INDICATE HERE
ROOM # ROOM NUMBER HERE
Faculty Referred Exams – Testing Center Guidelines
When dropping off any exams, please complete the NVCC Annandale – Testing Center Services Request Form completely, accurately,
and legibly.
By dropping off or taking an exam in the Testing Center, it is implied that students and instructors agree to adhere to the policies
and guidelines set by the Testing Center, even those not explicitly stated, including but not limited to: cut off times and test
collection times. For guidelines regarding proctoring Faculty Referred Exams, see below.
This is the last day the
test can be
administered and may
include time. (ie.
Completed by 5pm)
If you are aware the
student has documented
accommodations (from
counseling) on file with
the Testing Center.
Accommodations will be
given to documented
SWA regardless if the box
is checked.
If mail is selected,
delivery times may vary.
The Testing Center does
not have control over
tests after they are sent
to the mail room.
General Guidelines:


All faculty referred exams must be started at least 90 minutes prior to closing regardless of time limits imposed by the
instructor.
All exams must be dropped off or picked up at least 30 minutes prior to closing.
Proctoring of Faculty Referred Exams is available for:




Students with documented Accommodations
Students who miss the original test date due to illness, family related emergency, and prearranged cases to be determined
by instructor.
Students who need additional monitoring while testing.
For any other exceptional circumstances, please contact the Testing Center Supervisor, Jason DeFreitas, at
jdefreitas@nvcc.edu, BEFORE filling out the Services request form or dropping off any tests.
At this time we do not proctor exams for entire classes. In addition to this policy, we ask that instructors:



Limit the number of exams they drop off to eight (8) exams per day.
Limit the number of exams to eight (8) students per day.
Do not have multiple exams on file with the same end date, and that no end date fall on a Saturday.
Requests for extensions for exams already in the Testing Center must be submitted to antesting@nvcc.edu.
During the scheduled final exams week, we proctor Faculty Referred Exams for Students with documented Accommodations ONLY.
No Exceptions. 