Make-Up Test Instruction Form **Test submissions are required 2 business days in advance** $25.00 fee applies Make-up tests for Accommodated Students must be submitted on the form provided to you via email from Student Services. South Campus SCCCA Chatham Make up Monday to Thursday 3:00 pm - 9:30 pm by appointment only by appointment only test times Friday 12:00 pm - 5:00 pm. Test Submission Room 206 Room 127 Room 133 options FIRST Name: Student Number: Course Code: Student’s LAST Name: Student’s Length of Time CLASS Date Time ORIGINAL test date received to do original Make-up Test to be written: Make-up Test to be written: test: Is the student required to complete a SCANTRON? Yes No Are CALCULATORS allowed? Yes No INSTRUCTOR Is this an OPEN BOOK test? (TEXTBOOK only) (NOTES only) (TEXT & NOTES) Yes No BY Can the student use a DICTIONARY? Yes No Can the student use OUTSIDE SOURCES? (INTERNET/ONLINE SOURCES) Yes No OUT BATHROOM breaks? Yes No Can the student use a FORMULA SHEET? Yes No COMPUTER required? NAME of SOFTWARE required: Yes No FILLED Are there any other special instructions? BE If we need to contact you for clarification of questions, where can you be reached? TO Classroom: Classroom Extension: (optional) Cellphone: Faculty Name: Faculty Date: Signature: Date: Started: Allotment: Completed: TIME: Seat #: _______ Checked Photo ID USE Student Signature: X Test Proctored By: Proctor’s Notes: OFFICE Confirmation of Test Pick-Up (By Faculty) Instructor’s FOR Date: Signature:
Make-Up Test Instruction Form **Test submissions are required 2 business days in advance** $25.00 fee applies Make-up tests for Accommodated Students must be submitted on the form provided to you via email from Student Services. South Campus SCCCA Chatham Make up test times Monday to Thursday 3:00 pm - 9:30 pm Friday 12:00 pm - 5:00 pm. by appointment only by appointment only Test Submission options Room 206 Room 127 Room 133 TO BE FILLED OUT BY INSTRUCTOR Student’s LAST Name: Student’s FIRST Name: Student Number: Course Code: ORIGINAL test date Date Make-up Test to be written: Time Make-up Test to be written: Length of Time CLASS received to do original test: Is the student required to complete a SCANTRON? Yes No Are CALCULATORS allowed? Yes No Is this an OPEN BOOK test? (TEXTBOOK only) (NOTES only) (TEXT & NOTES) Yes No Can the student use a DICTIONARY? Yes No Can the student use OUTSIDE SOURCES? (INTERNET/ONLINE SOURCES) Yes No BATHROOM breaks? Yes No Can the student use a FORMULA SHEET? Yes No COMPUTER required? NAME of SOFTWARE required: Yes No Are there any other special instructions? If we need to contact you for clarification of questions, where can you be reached? Classroom: Classroom Extension: (optional) Cellphone: Faculty Name: Faculty Signature: Date: FOR OFFICE USE Date: TIME: Started: Allotment: Completed: Seat #: _______ Checked Photo ID Student Signature: X Test Proctored By: Proctor’s Notes: Confirmation of Test Pick-Up (By Faculty) Instructor’s Signature: Date: