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Appointment Request for Proctored Exam
Complete this form if you need to utilize the Jackson State Community College (JSCC) Testing Center to complete a proctored exam It is important that you do not wait until the last minute to schedule your appointment for testing in case of technical issues and/or scheduling difficulties. By completing this form you are agreeing to abide by all Testing Center policies procedures (
https://jscc.edu/academics/academic-services/library/aac/
). If you have questions or need assistance contact the Testing Center at
testing@jscc.edu
.
First Name
Last Name
J Number (J00-)
Email Address
Mobile Phone Number
What course (ex. MATH 1010) are you taking an exam for?
What type of test do you need to take?
JSCC proctored course exam (you are a student taking a class at JSCC and your exam must be proctored)
JSCC course exam (you are a student taking a class at JSCC and need access to a lockdown browser to complete your exam; but it does not have to be proctored)
TN eCampus exam (you are taking an exam through the TN eCampus system and your exam must be proctored)
Courtesy exam (you are a student at an institution outside of the Tennessee Board of Regents system and your exam must be proctored)
ACCUPLACER (you are a current or prospective JSCC student who needs to take placement exams)
Other
Provide additional information about test type, if applicable.
What is your test format?
Computerized
Pencil and Paper
Have you requested ADA accommodations for this test session? Please keep in mind that all accommodations must be approved by the Disability Resource Center.
Yes
No
What ADA accommodations have you been approved for, if any?
What ADA accommodations have you been approved for, if any?
Extended Time
Low Stimulus Environment
Private Room
Reader
Scribe
Not Applicable (none)
What is the time limit for your exam?
Under 1 hour
1-2 hours
2-3 hours
3 or more hours
Choose your
preferred
date for your proctored exam. Please keep in mind that we cannot guarantee available for your preferred date/time.
If you are taking an ACCUPLACER exam we schedule these exams for Tuesdays at 9:30 am and Thursdays at 1 pm.
What time, on this date, would you prefer to come in for your proctored exam?
If you are taking an ACCUPLACER exam we schedule these exams for Tuesdays at 9:30 am and Thursdays at 1 pm.
Is there another time on this date that you can come in if your preferred timeslot is not available?
Yes
No
Provide at least one back up date and time in case your preferred time is unavailable.
By signing this form you are acknowledging that the information you have provided is accurate, and that you agree to the abide by all Testing Center policies while testing.
Click to Sign...
Submit
