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Test Intake Form
Instructor Information:
Name:
Phone:
E-mail:
Course Information:
Course Subject & Number:
CRN:
Test Information:
Exam/Quiz #:
How many students need to take the test:
Time Expected for student to complete test:
Starting Date:
Starting Time:
Ending Date:
Ending Time:
Scantron: (Select "Yes" or "No")
Yes
No
Write on test: (Select "Yes" or "No")
Yes
No
Materials Permitted:
Calculator, Dictionary, Scratch Paper, etc.
Reference Material:
WebCT, Vista, Other
Special Instructions:
Materials will be available for pick up after 10am on the next testing day.
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