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Online Instructor Coversheet

NOTE: If you are scheduling more than one test or exam, please complete a separate form for each test.

*Required Fields
1. Personal Information
First Name:*
Last Name:*
Tech ID:*
Address 1:*
Address 2:
City:*
State:
Zip/Postal Code:*
Daytime Phone #:* (xxx-xxx-xxxx)
Alternate Phone#:
Email:* e.g. john.jones@metrostate.edu
2. *Course Information
Course Title Course Subj/ Number/ Section (eg MIS 100-02) Course Type Last date to take test (eg June 15, 2007) Type of test No.of test pages including cover sheet if any Location you want this test to be forwarded
Minneapolis
St Paul
3. List of students who are to take the test by name and tech ID (for an FDIS or online course, this could be supplied by transmitting the class roster)
Student First Name Student Last Name Tech ID
If there are more than three students please enter the Student First Name, Last Name and the Student Tech ID in the box separating with commas.
*4. After last day do you want the testing center to return or destroy materials?
*5. Testing Instructions (Select all that apply)

Timed open book . Book Title Book Author: If additional books, please specify

Timed open notes. If open notes, please select number of pages and size . If other, please specify
Calculator. Please select programmable, please enter if there are any exceptions regular no calculator permitted
Answer sheet supplied by instructor
Scratch paper
Timed test. If so, how much time. e.g. 1 hour
Special Instructions
6. *Instructions after completion of the Test:

Note: This form is also available in alternate format, please contact Disability Services at 651-793-1540 (TTY 651-772-7687)