South Campus Nursing MAKEUP Exam Request Form

Faculty member — Please fill out and submit this form to help us accommodate your testing needs.

NOTE: Fields marked with an asterisk "*" are required.

NOTE: Please only put one tester per form.

Please DO NOT pre-select examination times for the tester. All students taking this exam must schedule their exam with the DL Testing Centers- South Campus by calling 270-745-2953.

Exam Information

*Instructor’s Name:
*Office Room#:
*Phone#:
*Student’s Name:
*Course CRN:
*Course ID# (ex: NURS 555):
*Class Name:	Access Code
*Exam/Quiz#: OR Midterm    OR    Final

*First date student may complete this exam:
*Last date student may complete this exam:
*Maximum time allotted for exam/quiz:

*Format of exam:	Online   OR   Paper
*Website to be used by the student for the ONLINE Exam:
*Access Code/Password for the ONLINE Exam:
*Incomplete PAPER exams:	Shred   OR   Return to Professor   OR   Not Applicable

Student is permitted to use:

(If not marked, the testing staff will not allow students to use any of these items.)
Calculator	Yes   No	Restricted models:
Scratch Paper	Yes   No
Headphones	Yes   No
Notes	Yes   No
Textbook	Yes   No
Handouts	Yes   No
Scantron	Yes   No
Other (please specify)

Student must return the following items to proctor:

(If not marked, the testing staff will collect everything.)
Test/Quiz	Yes
Answer Sheet/Scantron	Yes   n/a
Scratch Paper	Yes   n/a
Handouts	Yes   No   n/a
Other (please specify)

Other specific instructions?

Important Info for Faculty Requesting Nursing MAKEUP Exams at SCTC

• Paper/Pencil Exams: Paper exams for all students must be given to the DL Testing Center no later than 48 hours prior to the first day the students may take the exam.
• If giving a paper exam, we will send an email when the exam is complete and that it is ready for pickup.
• All unused exams will be returned to the instructor unless other instructions are given.
• If you have issues or questions not covered by this form, please call the DL Testing Pro-staff at (270) 745-2953 or email sctc@wku.edu.