Proctored Test Instruction Form

Submit this form for every test to be proctored, paper or online.

For paper tests you may:
• Fill out this online form, upload the test, and click Submit. The Testing Room staff will print out the exam.
• Print this Word form, complete it, attach the paper test, and deliver to the Testing Room (B131 Quincy Campus).

Location
These instructions are for a test that will be taken at:
For Your Information (Quincy Campus)
Testing Room is in B131 of the Learning Resource Center. Contact: Becky Will - 217.641.4527
For Your Information (Southeast Center)
TESTING BY APPOINTMENT ONLY. Contact: Jaclyn Baker - 217.641.4570
For Your Information (Mt. Sterling Center)
TESTING BY APPOINTMENT ONLY. Contact: Jeanne Yingling - 217.641.4144
For Your Information (Ag Center)
TESTING BY APPOINTMENT ONLY. Contact: Ben Neisen - 217.641.4558
Instructor Information
Name Name First Last
Instructor may be contacted at (email or phone):

Note: Phone numbers will NOT be shared with students.
Course Name
Course Number (including prefix)
Student Names

Type a list of student names who should have access to taking the test, or upload a file containing the student names.
Student Name(s) (or attach a list below)
Upload a File with Students' Names (if you haven't given them above)

Attach Files
Test Information
Test to be taken (e.g. Chapter 2, Exam #1, etc.)
Test Date (Beginning) Test Date (Beginning) / MM / DD YYYY
Test Date (Ending/Must be completed by) Test Date (Ending/Must be completed by) / MM / DD YYYY
Is this a paper or online test?
If you would like the testing room to print out your test, upload it here. Otherwise, be sure to deliver the physical copies of the test to the appropriate testing room (B131 on Quincy Campus).

Attach Files
Directions for accessing the online test (e.g. in Canvas)
Does the test require a password?

Does the test require a password? Yes No
If so, please specify the password needed by the proctor.
Special Instructions

If any instructions do not apply (e.g. for a calculator if this is an English test), choose "no".
Is the test open book?

Is the test open book? Yes No
Are notes allowed for the test?

Are notes allowed for the test? Yes No
Is a calculator allowed for the test?

Is a calculator allowed for the test? Yes No
Is there a time limit for this test?

Is there a time limit for this test? Yes No
If so, how long is the time limit?
Other instructions / notes for the proctor:
Send a copy of this form to my email for my records
Email address

Proctored Test Instruction Form

Proctored Test Instruction Form

Location

Instructor Information

Student Names

Test Information

Special Instructions