Completed form must be received by ODS no later than 5 business days prior to the exam.

TEST PROCTORING FORM

Office of Disability Services Student Union Building 1 - Suite 2500, MSN: 5C9 Phone: 703-993-2474 Fax: 703-993-4306 Testing Hours: Monday - Friday 9 AM till 5 PM Tuesday 9 AM till 9 PM Email: ods@gmu.edu Website: http://ods.gmu.edu

STUDENT INFORMATION (to be completed by student)

Name Email Course Daniel Simposn
dsimpso3@gmu.edu
G Number 423150

Phone Number (703) 408-5950 Name Instructor Keith Jones

Act 738

I have read and agreed to comply with all ODS test policies and procedures for exam proctoring. I understand that the exam will not be administered if my arrival time is 20 minutes after the instructor's stated start time. However, if I am late and within the 20 minute window, I understand the amount of time I am late will be deducted from the total time allowed for the test. I agree to abide by the Mason Honor Code. I understand that violation of the Honor Code will be reported to the Office of Academic Integrity. I understand that the ODS testing center is monitored by cameras through a closed circuit security system. Signature Date

FACULTY INFORMATION (to be completed by professor)

Phone Number Date student will take exam Email

Wednesday, May 15, 2013

Start time of exam 9:40

Class time allowed for exam (without accommodations) INITIAL all materials allowed during test (initial at least 1) None Internet Access Additional Approved Materials/ Special Instructions

Open Book Simple Calculator

Open Notes Graphic/Scientific Calculator

Dictionary Scratch Paper

Personal Laptop, No internet access.

Exam Return (check one) Test will be picked up from ODS, SUB I, Suite 2500 Student returns the exam in a sealed envelope. Building/Room Date ODS Staff Only

Exam Delivery (check one) Test will be hand delivered to SUB I, Suite 2500 Test will be emailed to ods@gmu.edu Student delivers the exam in a sealed envelope Signature

Extended Time Other

1.5x

Computer

JAWS

Online Exam

CCTV

Read and Write Gold

If Other: Time Ended Room Number

ODS Test Form v.1.0 - March 2013

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