Student Accessibility Services Exam/Quiz Proctor Sheet

Professor/Instructor Please Fill Out Exam/Quiz Information

Student Name:

Course Name:

Subject:

Faculty Name:

Exam/Quiz Type: Multiple Choice: Essay: Math: Listening:

Phone/Email:

Date & time class takes exam/quiz :

Amount of time class receives for exam/quiz:

Did the student receive professor permission to take this exam/quiz on a different date/time thaƴ the class? Yes: No:

If yes, date(s)/time permitted:

S tudent May Use: Calculator Book(s) NotesScantron Color Preference:

I am aware of and understand the Kent State University administrative policy regarding student cheating and plagiarism (Policy Register 3342-307). I understand that I am NOT permitted to leave the testing room until I am finished with my exam/quiz. If I believe that I will need to use the restroom during my exam/quiz, it is my responsibility to let the SAS proctor know prior to the beginning my exam/quiz; and I understand that I will then need to complete the exam/quiz page by page, and will not be permitted to view or work on any previous pages when I return from being out of the testing room. I also understand Student Accessibility Services hours are Monday through Friday 8am-5pm and that there may be a change in SAS proctors during this exam/quiz and that my exam/quiz will be collected 15 minutes prior to SAS closing during the academic year and 30 minutes prior to SAS closing during final examinations.

Apt Date: _____________ M T W R F Week: ___________ Time: _______________

Student Signature: _________________________________________________________________ Date: _______________________________________

D ate Rcvd: _______ _____ Rcvd By: E D F O

Location: ____________________________

Room Alone Computer JAWS Braille Terp CCTV Enlarge: _______

Scribe Reader Proctor CD/TAPE DVD/VCR

Start Time: ________ Staff Initials: ________ End Time: ________ Staff Initials: ________ Total Minutes: _________ INCDT Report: N / Y

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CRN: Course & Section No.

Exam/Quiz Instructions:

Completed Exam(s): Pick up exam from SAS SAS delivers exam to Dept. Scan and e-mail

SAS Office Use Only

Other: _________________________

Delivery information:

Delivered by: ____________ Date: ________ Time: ________

Rcvd by (Signature): _____________________________________

Return Information:

(Print): _____________________________________

Delivered by: ____________ Date: ________ Time: ________Done by: ____________ Date: _________ Time: __________

Pickup (Signature): _______________________________________

(Print): _______________________________________

-

PC: Respondus: Other:

Amount of extended time permitted:

Total time for SAS student:

Student Cheating Policy & Exam/Quiz-Taking Expectations

min

min

min

+

__________ Staff Initial: __________ Proctor Sheet By: Professor SAS

University Library, Suite 100 ٠ P: 330-672-3391 ٠ F: 330-672-3763 ٠ E: sas@kent.edu