Instructor Exam Request Form

Proctored Exam Information for Online Instructors

I understand CourseDen-D2L is the official USG-supported course management system providing 24-hour/365 day a year support, security, back-up, disaster recovery, and documentation of student information, course records, and content. I understand that if I use tools hosted on alternate servers, through which neither USG or UWG has a service level agreement, I am accepting responsibility for the security and maintenance of student records and course content, student support, and making sure that my use of this outside tool is in compliance with all university policies covering data security, records retention, and any others there may be, along with any legal requirements, such as FERPA.

I have read and agree to the above terms.
* Enter "I agree":

Instructor Information

* First Name:
* Last Name:
* Department:
* Email Address:
* Phone Number:
* UWG Address:
 
Test Information

* Course Name:
(as it appears in CourseDen-D2L: ex. Algebra)
* Course ID: (ex: CEPD1101)
* Section Number: (ex. N01)
Maximum Number of Students Enrolled:
* Choose your test option: Online: (in Course Den-D2L)
Online: (not in CourseDen-D2L): Instructor is responsible for ensuring user-support.
Offline: Instructor is responsible for emailing exam as an attachment, to jgubbins@westga.edu, at least one week prior to exam
Specifc URL where students should log in to take exam:
Name of Test :
(as it appears in CourseDen-D2L or other)
Password for Proctors (if applicable):
* Requested Earliest Date Students can Take Test: (ex. 11/23/14)
* Requested Latest Date Students can Take Test:
* I confirm that I have talked with the UWG campus testing center (Francie Taylor, 678-839-6435, ftaylor@westga.edu) and the Newnan campus testing center (Teri Lewis, 770-254-7280, tlewis@westga.edu), in order to confirm that there should be available seats during this testing time frame. Please type "Confirmed" in the text field.
* Time Limit:
Additional information that the student or proctor may need to know:
* Will you also be offering to proctor this exam yourself, on the Newnan or Carrollton campus, at no charge to the students? Yes
No
If so, what is the date and time of this on-campus exam?
   
Allowable Items (check all that apply)

Calculator
Text Book
Class Notes
Crib Sheets
Scantron
Blue Book
Periodic Table
Colored Pencils
Rulers
Scrap Paper
None of the Above
Other

Please review your information above before submitting.