Testing Center Exam Referral Form

Valencia Community College Testing Center Exam Referral Form

Choose a Campus:
(Hold the CTRL key down for multiple selections.)

Instructor:

Extension:

Mail Code:

Course Prefix & CRN:

Exam Description:

Email:

(A confirmation will be sent to your e-mail account.)

Deadline Date/Time:

Share deadline information with students:

Time Limit:

Select Course Format:

Completed exams to be:

All exams will be mailed back or placed in pick up files the day after the specified deadline date.

Attach Test Here (One exam per referral, please.)

Resource and Answer Materials:
No materials or aids will be permitted with exams unless they are specifically stated on this referral by the instructor.

Calculator (specify type)
Clear Memory

Scantron (specify type/color) Students may answer on test

Blue Book/Essay Book ( specify type )

Pencil Only Pen Only: blue / black

Textbook Notes Tables/Charts

Dictionary Thesaurus Other (specify)

Information/Instructions/Comments/Disability Accomodations:

Please attach class roster here or fill in students names below:

Student Name/VID Number:
(Last, First) Date Taken: (staff only) Number of Exams Received:

1.

2.

3.

4.

5.

Choose a Campus: (Hold the CTRL key down for multiple selections.)
Instructor:
Extension:
Mail Code:
Course Prefix & CRN:
Exam Description:
Email:	(A confirmation will be sent to your e-mail account.)
Deadline Date/Time:
Share deadline information with students:
Time Limit:
Select Course Format:
Completed exams to be:

All exams will be mailed back or placed in pick up files the day after the specified deadline date.

Attach Test Here (One exam per referral, please.)

Resource and Answer Materials: No materials or aids will be permitted with exams unless they are specifically stated on this referral by the instructor.
Calculator (specify type)			Clear Memory
Scantron (specify type/color)			Students may answer on test
Blue Book/Essay Book ( specify type )
Pencil Only	Pen Only: blue / black
Textbook	Notes	Tables/Charts
Dictionary	Thesaurus	Other (specify)

Information/Instructions/Comments/Disability Accomodations:
Please attach class roster here or fill in students names below:

Student Name/VID Number: (Last, First)	Date Taken: (staff only)	Number of Exams Received:

1.
2.
3.
4.
5.