Proctoring Form
INSTRUCTOR’S REQUIREMENTS
(A copy of this document will be provided to the proctor)
INSTRUCTOR’S INFORMATION
Name ______________________________
E-Mail Address __________________________________
Phone: Work ________________ Home: _______________Cell Phone: _________________
EXAM INFORMATION
Name _____________________________Crn ___________
Exam Title Or Number
___________________________
Exam Type: Quiz ___ Mid Term ___ Final ___ Other _____
Dates For Exam: Earliest ___________________ Latest: ________________________
LIST OF STUDENTS WITH PERMISSION TO TAKE THIS EXAM
Student name
Student ID
Exam monitor: please verify student by checking their photo ID such as a driver’s license. Please
verify that the following criteria are adhered during the test:
ADMINISTRATION INSTRUCTIONS FOR THE EXAM PROCTOR
Open Book: Yes ___ No __ If Yes, Texts That Can Be Used Are:
Title/Author_________________________________________________
Title/Author_________________________________________________
Open Notes: Yes ___ No ___
Use Of Formulas Sheet: Allowed ____ Not Allowed ___
Use Of Calculator: Allowed _____ Not Allowed ___
Computer Resources Allowed: None ______ Other _____
Time Limit ________
EXAM PASSWORD: _________________
REMINDERS:
2001 Union Carbide Drive • South Charleston, WV 25303 • Phone: 304-205-6600 • Fax: 304-205-6772
619 2nd Avenue • Montgomery, WV 25136 • Phone: 304-734-6600 • Fax: 304-734-6630
Formerly Bridgemont and Kanawha Valley Community and Technical Colleges
Equal Opportunity • Affirmative Action Employer