AIRPORT CAMPUS
Counseling & Career Services
Midlands Technical College
PO Box 2408
Columbia, SC 29202
Phone (803) 822-3505 Fax (803) 822-3295
E-mail: disability@midlandstech.edu
Student Center 237
BELTLINE CAMPUS
Counseling & Career Services
Midlands Technical College
PO Box 2408
Columbia, SC 29202
Phone (803) 738-7636 Fax (803) 790-7515
E-mail: disability@midlandstech.edu
Student Center 239
TEST PROCTORING FORM
Please complete this form and return it to Counseling Services with the exam by 12:00pm noon the day before the test.
STUDENT INFORMATION
Student’s Name:
Student’s MTC ID#:
Student’s Email Address:
Student’s Phone #:
Student’s Test Accommodations:
INSTRUCTOR & COURSE INFORMATION
Instructor’s Name:
Course/Section #:
Instructor’s Email Address:
Instructor’s Contact #:
Test Title:
Total Time Allowed for Test in Class
Test Completion Deadline: Test to be completed by:
Special Instructions:
Test Delivery Information:
Test will be hand delivered to C&CS by instructor or faculty designee.
Test will be delivered via email to C&CS via disability@midlandstech.edu.
Test will be delivered via fax to C&CS at 822-3295 (AC) or 790-7515 (BC).
Online Test Information: Password:
Test is Online on D2L.
Test is Online on MyMathLab.
Test is Online on MyITLab.
Test is Online at
Test Return Information:
Test will be picked up by instructor or faculty designee.
Test will be delivered via email to instructor at
Test will be delivered via fax to instructor at
As the instructor for the above listed course I grant permission for the above named student to take the above mentioned test with
Counseling & Career Services Test Proctoring Services.
Signature:
Date:
Counseling & Career Services Staff Only:
Receipt Date:
Staff Initials:
Return Date:
Test Date:
Estimated Stop Time:
Time Started:
Staff Initials:
Actual Stop Time:
Counseling & Career Services Revised 05.2013