Exam Submission and Request for Alt. Testing

Exam Submission Form and Request for Alternative Testing
Instructor Use ONLY - please submit to the Testing Center (testingcenter@bluecc.edu)

Note: *All fields are required. Completed form must be submitted minimum 1 week prior to Exam Date. Questions? Contact the Testing Center at 541-278-5931 or testingcenter@bluecc.edu.
Instructor name
Instructor email:
Course name
Exam
Exam Start Date

MonthDayYear
Date
Exam End Date

MonthDayYear
Date
Course Delivery (check one)
Exam Type (check one)
If Paper Exam, please upload documentation

Cancelof
Standard protocols (violations could result in 0 grade on exam)
- Students are prohibited from the following unless indicated in the notes below
  - Receiving help from other individuals
  - Using notes
  - Using any textbook
  - Receiving assistance from any source during the exam
- Exam rules unless indicated in the notes below
  - Recommended 2-hour time limit
  - Must finish in 1 attempt
Enter time limit here
Exam password (example - BlueMt21!) If none, state "none"
Items Allowed (example - calculator, scratch paper) Note: if nothing is listed here, we will restrict all items from the student, including scratch paper
Other notes or special instruction as needed (example - scan scratch paper)
Alternative Testing Information
Please use this area for student-specific testing options. This is required for students with accommodation provisions.
Student Name
First date student can test

MonthDayYear
Date
Last date student can test

MonthDayYear
Date
Please indicate below the reason for making this request

Other
Please list what accommodations the student(s) are allowed:
BMCC Testing Center Location
INSTRUCTOR SIGNATURE
DATE

MonthDayYear
Date
Should be Empty:

Exam Submission Form and Request for Alternative Testing

Alternative Testing Information