ARCHIVED - Medical Campus - Instructor Request Form

THIS FORM HAS MOVED

PLEASE SAVE AND USE THE FOLLOWING LINK FOR SUBMITTING TESTING REQUESTS:

Instructor Name

First Name

Last Name

Course Title

Test Type

Online/In-Class Exam Make-Up Exam ATI Exam

Cohort & Graduation Date

(Example: GFT - 12/26)

What platform will be used to launch the exam?

Canvas (via Lockdown Browser) ExamSoft (Examplify) ExamDriver JBLearning

Other:

Name of ATI Exam

(Example: Nutrition)

Assessment ID

Are all students able to provide their own laptops?

Yes No

Please provide the number of laptops needed for your class.

Please provide the room number where laptops should be delivered.

Office Phone

Cell Phone

Email

Test Date:

:

Time allotted for exam:

Please acknowledge:

I understand that I (or someone I appoint) will be required to proctor my class for the duration of the exam time listed above.

Number of Students

Students may use notes/textbook/formula sheets

Yes No

Please specify what is allowed

Scrap paper may be used

Yes No

Students may use calculators

Yes No

Authorized Test Aids

NOTHING Scrap paper & Pencil On-Screen Calculator Notes/Text Book/Formula Sheets

Please acknowledge:

I understand that the Testing Department will no longer supply physical calculators and I will need to activate the digital calculator via the exam

Password required?

Yes No

What is the password?

Upload Attachment (Please attach roster and/or exam)

No File Chosen

File uploads may not work on some mobile devices.

FORM NO LONGER ACTIVE*