DRD Testing Parameters Form- Petaluma

DRD Testing Parameters Form

Petaluma Campus- Richard Call Building, Room 608

Drop-In Testing

*Forms must be submitted 1 week in advance for Finals Week only

Exam must be completed: Monday-Thursday 8:15am-4:30pm

Student's Name(s)

Instructor's Name*

First Name

Last Name

Instructor's Email*

Course*

Exam Date*

Additional dates

Start Time

Anytime on Approved Exam Date Instructor Selected Time

Instructor Selected Time

Length of exam WITHOUT extra time

ACCOMMODATIONS AUTHORIZED FOR THIS EXAM:

Extended Time Assistive Technology (Read & Write Gold, Dragon, etc.) Other

Extra Time

1.5x 2x

Type of Assistive Technology (Read & Write Gold, Dragon, etc.

Other:

Please check all that apply

Calculator Allowed Computer Required Open book Notes Allowed Other (Scantron, Blue/Green Book, etc.)

Calculator Allowed

Basic Scientific Graphing

Open Book: Text:

Notes Allowed:

Other (Scantron, Blue/Green Book, etc.):

Additional Instructions

UPLOAD EXAM HERE

No File Chosen

File uploads may not work on some mobile devices.

If no exam is uploaded, please mark the box for how you plan to submit the exam.

Delivering a hard copy of the exam to Richard Call 608 BEFORE the start of the exam. Emailing the exam to drd-testing-pet@santarosa.edu BEFORE the start of the exam. Sending the student with the exam in a sealed envelope at the time of the exam. Delivering a hard copy of the exam to the DRD EXAM DROP-OFF mailbox in the Richard Call Faculty Mailroom at least 1 day before the exam.

How will the exam be returned?

Instructor will pick up from proctor Mon-Thurs, 8am-5pm (Richard Call 608). Exam delivered to Instructor's mailbox in the Richard Call Faculty Mailroom. Student Self-Deliver to Instructor (in a sealed envelope).

Instructor Signature*

[clear]

Use your mouse or finger to draw your signature above

Instructor Phone Number

DRD OFFICE USE ONLY:

Start-Time:___________ Max-Time:__________Time-Completed:___________ Proctor:__________________________

Delivered-By:________________ Pick-Up-Signature:______________________________