*Professor Name: *Email: *Course Name:
*Phone Number where the Professor can be reached:

Will there be an examination for this course this semester?    Yes    No
What type of exam is this request for?   Midterm     Final
 
Will you allow students to take this examination on laptop computers using Extegrity Exam 4.0 software?    Yes    No
Please select the mode you wish to use for the exam:
Closed mode - students will not have access to their computers or the internet
Open mode - students will have access ONLY to their computer hard drive
Open Network mode - students will have full access to their hard drive and the internet

Please provide the following information if this will be a classroom examination:
Examination Length (in hours):
Closed Book    Open Book    N/A

Please provide the following information if this will be a paper or take-home examinaton:
Take-Home    Paper    N/A
 
What date/time will students begin the paper or pick up the examination?
 
Where will students pick up the examination or instructions for the paper?
In Class    On Campus Office    Registrar's Office    Other    N/A
 
What date/time is the test or paper due?
 
Where will students submit their completed examinations or papers?
In Class    On Campus Office    Registrar's Office    Other    N/A
 
Can students mail or e-mail their papers or examinations to the Registrar's Office?
Mail    Email    N/A
 
Special Requests or Comments regarding exams: