EMCC Student Success Center
Test Proctoring Form
Telephone: 207-974-4868
Maine Hall, Room 121
-Dear Instructor:
The Student Success Center (SSC) is available to proctor exams/quizzes for students who require testing
accommodations. The SSC can also proctor exams/quizzes for non-disability students who need to make up missed
exams/quizzes on a space available basis. All students will be required to schedule a testing appointment in order to take a
test in the SSC. We ask that you complete the section below, and email or drop it off to the SSC with your exam at least a
day in advance of the scheduled test. Exams can be emailed to success@emcc.edu. Please attach this page along with the
test in Microsoft Word format. If you have any suggestions or questions, please do not hesitate to contact Amy Sturgeon in
the SSC.
To Be Completed by Student or Instructor
Student’s Name: Click here to enter text.
Instructor’s Name:Click here to enter text.
Course Title & Section: Click here to enter text.
# Classes Per Week: Click here to enter text.
Date & Time student is scheduled to take exam at SSC: Click here to enter text.
To Be Completed by Instructor
Type of Test: (please check the appropriate box): Test for a student with accommodations
☐
Test for a student without accommodations ☐
Date/Time the class is scheduled to take the exam: Click here to enter text.
Time allotted to ALL students for quiz/exam: Click here to enter text.
Exam Accommodations for Students With
Disabilities: (to be filled out only if the student is registered with
the Disability Services office and has been approved for accommodations)
Computer ☐ Kurzweil ☐ Scribe ☐ Reader ☐
Calculator ☐
Extended Time: 50% ☐ 75% ☐ 100% ☐
Special Instructions (materials to be used):Click here to
enter text.
Open Book ☐ Notes ☐ Other Click here to enter text.
Additional Comments: Click here to enter text.
Click here to enter text. Click here to enter text.
Method for Returning Exam: Instructor will pick up exam in SSC ☐
Return to Instructor’s Mailbox ☐
To Be Completed By SSC Staff
1. EXAM RECEIVED BY SSC: Date
2. EXAM STARTED:
Date
3. EXAM COMPLETED:
Time
Time
Time
Signature
Signature
Signature ____________________________________
4. EXAM PICKED UP BY INSTRUCTOR: Date
Time
Signature