Clovis Community College Center
Disabled Students Programs & Services (DSP&S)
REQUEST FOR MAKE-UP TEST PROCTORING
The following student is requesting make-up test proctoring services.
STUDENT & TEST PROCTORING INFORMATION (Must be completed by Student/Student Services)
Student Name:
ID#:
Date:
Course:
Instructor:
Class Day(s)/Time:
Section #:
Test Description:
Actual Test Date /Time:
The student scheduled the following appointment for Make-Up test proctoring services.
TEST IS SCHEDULED TO BE PROCTORED ON:
Date:
Time:
TEST INFORMATION AND INSTRUCTOR NOTIFICATION (Must be completed by Instructor)
 I confirm the actual test date/time identified is correct.
*For concerns regarding the scheduled date/time for test proctoring, contact Claudia Hernandez (ext. 5276).
The amount of testing time the general class will receive will be
Hour(s) and
Min.
Please indicate resources the student is ALLOWED TO USE for the test (mark all that apply):
Open Book
Notes:
Calculator:
Course Aides (i.e., periodic table, chart, protractor):
Special instructions:
NO ADDITIONAL RESOURCES ARE ALLOWED.
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Completed tests will be returned to instructors via method selected below (please mark only ONE):
Deliver to instructor’s mailbox after 4:00pm.
Instructor will pick up Test from Student Services.
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Instructor Phone#:_________________
Instructor Signature:
Date:
Please deliver the request for make-up test proctoring and test materials, in a BLUE envelope, to the
Student Services office (between 8am and 5pm) or to Admissions and Records office between 5pm and
6pm. Please submit all tests at least 48 hours prior to the expected test date/time. Request form and
test materials may also be emailed as an attachment to claudia.hernandez@scccd.edu .
***STUDENTS MAY NOT DELIVER TEST MATERIALS.***
**************************** TESTING SERVICES-OFFICE USE ONLY ****************************
Total Minutes Allowed:
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Start Time:
Stop Time:
Test was appropriately implemented and completed by student.
Test was not administered to student due to: _____________________________________________
Testing Comments/Concerns: ________________________________________________________
_______________________________________________________________________________
TESTING SERVICES HOURS OF OPERATION FALL 2014
Monday
Tuesday
Wednesday
CLOSED
10:00am-6:00pm
*By Appt. Only
10:00am-6:00pm
*By Appt. Only
 Testing is by appointment only.
 Appointments for Testing Services are required to be
made at least 48 hours in advance to insure test
materials will be received.
Thursday
Friday
CLOSED
10:00am-2:00pm
*By Appt. Only
 A photo ID is required for testing.
 Students need to arrive on time with ID ready.
 All tests must be completed by the posted closing time.
HOW TO REQUEST A MAKE-UP TEST:
INSTRUCTOR RESPONSIBILITIES:
1. Inform students of the make-up test process and rules and guidelines for testing with Testing Services (found in
Faculty Forms on website under CCCC Make-Up Testing Rules & Guidelines).
2. Agree upon a day, with 48 hours advance notice to testing services, to have student set their appointment to
come take the exam.
3. Send student to the Counseling office in AC2-133 to make their appointment. Students must go to the
Counseling Office to schedule their Make-up exams BEFORE returning paperwork to instructor to be filled out
and handed in with exam.
4. AFTER the appointment has been scheduled, the student will return with Make-Up Test Proctoring Request
Form. Fill out instructor portion completely and then submit the request form and test materials:
a. To the Student Services Office between the hours of 8:00am-5:00pm (in a blue envelope).
b. To the Admissions & Records Office between the hours of 5:00pm-6:00pm (in a blue envelope).
c. In an email with the request scanned in and the test to claudia.hernandez@scccd.edu as attachments.
STUDENT RESPONSIBILITIES:
5. Report to room AC2 175 on day of scheduled appointment and quietly enter with a picture ID and any
allowed testing materials.
6. Leave all personal items (any items not allowed for the test, including cell phones) in a secure area.
7. Complete as much of the test as possible in the designated time frame as determined by the instructor.
8. Submit the test and all test materials to the test proctor, once the test is completed or the designated time
allowance has been reached.
TESTING SERVICES RESPONSIBILITIES:
9. Maintain security of the test and testing materials.
10. Proctor test with instructor specified/approved resources/instructions.
11. Return the completed tests, notes, etc. to instructor via the method selected on the request form.
12. Report any testing irregularities to instructors (i.e., cheating, unapproved materials/notes, no-show).
SECURITY AND COMPLETE CONFIDENTIALITY OF TEST MATERIAL IS A PRIORITY AT ALL TIMES
If you have any questions regarding test proctoring/coordination, please contact Claudia Hernandez at
claudia.hernandez@scccd.edu or phone ext. # 5276.
Revised 8/6/14