Texas State University-San Marcos
Office of Distance and Extended Learning
Exam Request Form
You are NOT REQUIRED to complete this form if you plan on taking your exam at Texas
State University-San Marcos; please refer to “Exams” on the Course Procedure Web Page
(http://www.correspondence.txstate.edu/students/course-procedure.html).
Do not enclose this request with an assignment.
You may not take two exams in the same course on the same day.
You must take the exam under proper supervision in an educational setting: accredited colleges,
universities, junior/community colleges, testing centers, military education offices, or public
libraries.
Course: ___________________ Exam requested (circle one): Exam I II III IV Midcourse Final
Examination Proctor (please print)
Official Title
School or Institution Name
School or Institution Address
Telephone (
)
E-mail Address
Charge for administering exam
Student
PLID (Texas State students) or SSN (non-Texas State students)
Address
Daytime Telephone (
)
E-mail Address
Exam Request Form — 1
EXAM REQUEST FORM
You must submit all required assignments before the exam will be mailed. For some courses,
you must receive all graded assignments before the exam will be mailed. Allow two weeks for
the exam to arrive at the testing site.
Circle One
Would you like this exam sent via courier service?
YES
NO
Do you have any outstanding charges with our office? If you have incurred any fax, postage due, or other charges, you can enclose
your payment with this form. Your grade will not be forwarded to the
Registrar until payment has been received. If you are unsure about current
charges, contact our office.
YES
NO
Are you a candidate for graduation this semester?
If yes, remember to allow approximately seven weeks (from the date you take
a proctored final exam) for your grade to be reported. Don’t forget processing
and mail time for your exam to arrive at the testing site.
YES
NO
Would you like us to send you a new catalog?
YES
NO
A $10.00 administrative fee will be charged for this service, in addition to shipping
charges required by the courier. We accept MasterCard, VISA, and American Express.
Card
Print name as shown on card
Account Number
Expiration Date
Authorized Signature
If paying by debit card, provide billing address zip code.
EXAM REQUEST FORM
Fill out this form and mail or fax it to our office.
Texas State University-San Marcos
Office of Distance and Extended Learning
601 University Drive
San Marcos, TX 78666-4615
Fax: 512.245.8934
2 — Exam Request Form