Test Proctoring Request Form
Disability Resource Office
Tyler Hall Room 61 831-6350
INSTRUCTIONS FOR COMPLETING THIS FORM ARE ON THE REVERSE SIDE
Please fill out completely and return to the DRO 2 working days prior to the exam date.
Student’s Name: ________________________________________________________________________________
*Date and Time of Test Room Reservation: __________________________________________________________
*Student’s may begin exams at 8am and must be finished at or before 5pm (7:30 am to 4pm during summer sessions)
Course Name and Number: ________________________________________________________________________
Instructor’s Name: ______________________________________ Instructor’s Phone #: _______________________
TO BE COMPLETED BY INSTRUCTOR:
I
How will the exam be delivered to the DRO? (note: please do not use campus mail; lost exams cause stressful situations)
 With the student in a sealed envelope
 By the Instructor
 By the Instructor’s Designee
 Email
 Other: __________________________________________________
II
How will the exam be returned to the instructor? (note: the DRO does not return exams via currier or by campus mail;
 With the student in a sealed envelope
 By the Instructor
 By the Instructor’s Designee
 Email
 Other: __________________________________________________
III
Materials allowed in exam room: (note: all book bags, cell phones, coats, purses, etc. will not be allowed in the exam room)
 calculator
 scrap paper
 class notes
 work book
 exam is open book, open note
 formula sheet
 note cards
 study guide
 Other: ________________________________________
 Other: __________________________________________________
_____________________________________________________________
Instructor’s Signature
_________________________
Date
_____________________________________________________________
Student Signature
_________________________
Date
FOR DRO USE ONLY
Test Receive in DRO: Date: ________ Time: ________ Staff Initials: ________
Test Proctored By: Staff Initials: ________ Room: 1 2 3 4 Other: ___________________________
Time Started: ________ Time Ended: ________ Times Checked: _______________________________
Test Returned By: __________________________ Date: ________ Time: ________ Digger: ____
Radford University does not discriminate with regard to race, color, sex, sexual orientation, disability, age, veteran status, national origin, religion or political affiliation in
the administration of its educations programs, activities, admission or employment practices.
R4/08
TEST FORM INSTRUCTIONS
DISABILITY RESOURCE OFFICE
This form is to be completed by all students who plan to take tests at the
Disability Resource Office (DRO).
1. Students need to discuss test arrangements and complete the form with their instructors.
a. The instructor may choose to administer the test in accordance with accommodations.
b. The test may be proctored by DRO staff within the DRO’s specific test-taking hours. The
instructor may contact the DRO to schedule an alternative time or arrangement if
scheduling conflicts arise.
2. It is the student’s responsibility to have the form completed and return it to the DRO at least
two (2) working days before the date of the examination. If test forms are not returned to the DRO two days
prior to exam time, it is at the DRO’s discretion as to whether the late request causes undo hardship to
accommodate the student.
3. If the exam is being hand-carried to the office by the student, please send it (and a second
copy if the test is to be read to the student) in a sealed envelope noting the time the student leaves your office.
DRO staff cannot pick up or deliver tests. The professor may fax, email, or hand carry the exam to the DRO.
4. Upon completion of the exam, the DRO proctor will place the exam in a sealed envelope,
indicating the time the test was completed. Exams are returned as indicated by the instructor.
5. Only materials allowed by the instructor may be brought into the testing room and these
materials must be specifically indicated on the test form.
6. No jackets, book bags, purses, cell phones, or palm pilots are allowed in the testing rooms.
Food and drink are permitted with the understanding that no food items or containers are left behind.
7. The HONOR CODE is in effect. Students will be proctored closely at regular intervals.
8. Any changes in time or conditions indicated on the form must be approved by the instructor.
DRO staff does not have the authority to approve such changes.
Thank you,
DRO Staff
Disability Resource Office. Tyler Hall, Lower Level Suit 54-69
PO BOX 6902 PH: 831-6350 FAX: 831-6525 EMAIL: dro@radford.edu
Radford University does not discriminate with regard to race, color, sex, sexual orientation, disability, age, veteran status, national origin, religion, or political affiliation in
the administration of its educational programs, activities, admission or employment practices.
11/09