/ Exam Request Form
Exam Request Form
Student Requesting Proctored Exam
Cell Phone Number
Course Instructor Information
Class section (01A, 02A, etc)
If you are unsure of your class section, please refer to your class schedule which can be found by logging into your student banner account.
Course Instructor (last,first)
Instructor Email Address
If you are unsure of your instructor's email address please refer to your course syallbus or the CSB/SJU online directory: http://apps.csbsju.edu/directory/
Date the exam is schedule to be taken in class (Regularly Scheduled Exam Time)
Date requested for exam to be taken in the Disability Services Testing Center
Requested Proctored Exam Start time
Remember to schedule your exams within our operating business hours of M-F from 8:00 A.M. to 4:30 P.M.
Test Name/ID (i.e. Exam I, Unit 4 Exam, etc.)
Approximate end time
I have scheduled to take this exam
During the regularly scheduled exam time (when my peers will be testing)
At a different time than my class due to a scheduling conflict (Requires explanation at the right).
If applicable, briefly describe why you are testing outside the regularly scheduled exam time.
I plan on taking this exam:
In the Disability Services Test Center at CSB
In close proximity to my classroom as arranged with instructor.
I am requesting the following exam accommodations (The student must be approved for option checked).
Extended Time - 1.5x
Extended Time - Other
Other - Please Describe in Comment Box Below
Comments/Concerns/Additional Information Regarding this Exam
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Information for Faculty
Information/Resources for Students