To be completed by the proctor. Once the student has completed the proctored examination, please complete this form and return it along with the examination to the professor.

Directions for the Proctor: This is a 2-hour, open books, notes and calculator-based examination. All unauthorized materials will be removed by the proctor. Since the exam is timed, ten minutes prior to the designated time is over, the proctor will give a warning that the examination period is almost over. A five minute warning will also be given.
You may fax or even send the hand written solutions by mail. Thank you.

Re-scheduling: All students are expected to take their examinations at the time scheduled unless for valid reasons they have the professor's approval to reschedule the examination.

STUDENT INFORMATION

Student Name:__________________________________________

Student ID (orSS#):_____________________________________________

Date of Examination:_____________________________________

Location of Examination:__________________________________

PROCTOR INFORMATION

Name:_________________________________________________

Title:__________________________________________________

Relation to Student:______________________________________

As Proctor for ________________________ examination, I certify that I was present throughout the period of the exam and that all the above rules were followed.

Signature:____________________________________ Date:________________________