Disability Services
Monica Kersting, Disability Services Coordinator
Academy 106
P: 218-299-3514
F: 218-299-4557
kersting@cord.edu | counseling@cord.edu
EXAM REQUEST FORM
Student Requesting Proctored Exam
Full Name:
Concordia Email Address:
Student ID #
Phone Number:
Instructor Information
Course Name:
Instructor’s Name:
Course Number:
Instructor’s Email:
Test Information
You must take your exam at the same time as your peers unless this is a make-up test, the test is for a night class, or your allotted
test time would go beyond office hours of 4:30pm. Only with the approval of your instructor may you take your test at a different
time. * Per proctoring hours, your exam MUST END BY 4:30pm.
Date and time everyone is scheduled to take the exam in class:
Date
Starting & Ending Time for the Exam
If applicable: Date & Time you are REQUESTING to take exam through Disability Services (only in the cases described above):
Date
Starting & Ending Time for the Exam (DON’T include your extended time here if that applies to you)
Please indicate your reason for testing at a different time:
Please check your approved accommodations:
Extended Time 1.5X
Extended Time 2X
Distraction-Reduced Space
Private Room
Use of Word Processor for Essays
Test in Electronic Format
Use of Calculator
Reader/Recorded Exam
Scribe/Dictated Exam
Other
Comments/concerns/additional information regarding this exam:
Student Confirmation
This form is complete to the best of my knowledge. I have read and understand the Testing Accommodation Procedures
(attached to this form) and agree to follow its policies.
Please return this form via email, fax, or in person to:
Disability Services Office, Academy 106
Attn: Erika Tomten, Administrative Assistant
Email: etomten@cord.edu
FAX: 218-299-4557
Phone: 218-299-3514
Office Hours: Monday – Friday, 8:00am – 5:00 pm
Counseling Center & Disability Services
Academy 106
To:
From:
Re:
901 8th St. S., Moorhead, MN 56562
Phone: 218-299-3514
Fax: 218-299-4557
Faculty and Students
Monica Kersting
Disability Services Coordinator
kersting@cord.edu
Testing Accommodation Procedures
Testing Accommodation Procedures
Whenever possible, it is the instructor’s responsibility to locate an alternate testing room for students needing testing accommodations.
If it is mutually decided that the student will need to take the test through Disability Services (DS), then the student and instructor
shall continue with the following procedures.
General Information

Test proctoring takes place in the Academic Enhancement and Writing Center (AEWC) and through the coordination of the
Disability Services office and Student Success & Retention office. Concordia’s Peer Mentors act as exam proctors. Prior to
your exam time you must check in to the Student Success & Retention office in Fjelstad B02 (lower level).

Proctoring hours are from 8:30am – 4:30pm, Monday through Friday. If an exam starts later in the afternoon, you must have
enough time (including your extended time, if applicable) to complete the exam by 4:30pm. Otherwise the exam time must
be scheduled earlier in the day.
Student Guidelines & Responsibilities

To request testing accommodations through Disability Services, fill out an Exam Request Form (found on the Testing
Accommodations web page), or obtained from the Disability Services office) and return to the DS office in person (Academy
Hall 106), by email to Erika Tomten (etomten@cord.edu or counseling@cord.edu) or by FAX (218.299.4557). This form
should be returned to the DS office AS SOON AS POSSIBLE to give us enough time to find a proctor for the specific testing
time you’re requesting. This must be done at least 5 business days before the exam. Once we receive your request you will
receive a confirmation email with the details of your request. We will work to arrange a proctor and secure the exam from
your instructor.

Meet with your instructor prior to the exam date to discuss the accommodations that you will need, and make sure these
needs are included on your exam request form.

If you are requesting a reader, scribe, interpreter, computer, or any other equipment, you must notify the DS office before you
fill out an Exam Request Form so we have enough time to find these resources for you.

During your test you may only have your exam, pencil/pen. Any additional resources, e.g., computers, calculators, etc., need
to be approved by your instructor and listed on the Exam Request Form. Bags, purses, coats, hats, electronic equipment and
other personal belongings must be left in the Student Success & Retention office.

Proctoring is not available for exams that are normally scheduled in the evening, so they will need to be completed during the
hours of 8:30am – 4:30pm.

On the day of your exam, check in to the Student Success & Retention office (Fjelstad Hall B02, lower level) a few minutes
prior to your exam start time.
Faculty Guidelines & Responsibilities

It is initially the instructor’s responsibility to locate an alternate testing room for students needing testing accommodations.
If this is not possible, testing accommodations shall be provided by Concordia’s Disability Services office.

The student should meet with you prior to the exam date to discuss the accommodations that will be needed. These needs
must be included on the Exam Request Form, which the student completes on their own, and can be found on the Disability
Services Testing Accommodations web page.

Please complete the Proctor Form and return it to the Disability Services office no later than 5:00pm the day before the
student is scheduled to take the exam. The Proctor Form can be found on the Testing Accommodations web page.
It may be returned to the DS office in person (Academy 106), by email to Erika Tomten (etomten@cord.edu), or by FAX
(218-299-4557).

The exam must be delivered to the Disability Services office in person or by email by 5:00pm the day before the test.
Emailed exams should also be sent to Erika Tomten. You are responsible for picking up the exam in the DS office when it is
complete, otherwise DS will scan the student’s exam and return it to you via email.

Proctoring is not available for exams that are normally scheduled in the evening, so they will need to be completed during the
hours of 8:30am – 4:30pm.
Tardies, Absences & Academic Honesty

If a student is a “no show” for an exam, the exam will be returned to the instructor and the student will need to make
arrangements with the instructor to make up the exam. There is no guarantee that the instructor will permit a make-up exam.

The student is expected to contact their instructor and the Disability Services office to cancel an exam due to illness or
emergency.

Disability Services does not have the authority to reschedule a test date or start time; this must be approved by the instructor
and notify the DS office by phone or email.

If the student arrives more than 10 minutes late for the scheduled exam, they will be given the choice of making other
arrangements with the instructor, or having the number of minutes late deducted from the time allotted for the exam.

The student is not allowed to leave the testing room once s/he has begun the exam.

Students must abide by the academic policies outlined in the Student Handbook in regard to Academic Honesty in all
dealings with testing accommodations. Any suspected evidence of cheating or use of unauthorized resources will be
documented by the staff and reported to the appropriate faculty member and Academic Affairs.
If you have further questions, please contact the Disability Services office:
Disability Services, Academy 106
Monica Kersting, Coordinator & Director
kersting@cord.edu
218-299-3514
Erika Tomten, Administrative Assistant
etomten@cord.edu
218-299-3514
FAX: 218-299-4557
Office Hours: Monday through Friday, 8:00am – 5:00pm