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 tha the class? Yes: No: If yes, date(s)/time permitted: Student May Use: Calculator Book(s) Notes Scantron 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: _______________________________________ Date 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 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: [email protected]