Oak Brook Exam Request Form

*Student First Name:

*Student Last Name:

*Student Email:

*Student Phone:


*Name of the course:

*Instructor First Name:

*Instructor Last Name:

*Date that the class is taking the exam:

*Time that the class is taking the exam:
— Select One —8:00am8:30am9:00am9:30am10:00am10:30am11:00am11:30am12:00pm12:30pm1:00pm1:30pm2:00pm2:30pm3:00pm3:30pm4:00pm4:30pm5:00pm5:30pm6:00pm6:30pm7:00pm7:30pm8:00pm to — Select One —8:00am8:30am9:00am9:30am10:00am10:30am11:00am11:30am12:00pm12:30pm1:00pm1:30pm2:00pm2:30pm3:00pm3:30pm4:00pm4:30pm5:00pm5:30pm6:00pm6:30pm7:00pm7:30pm8:00pm
*Requested Exam Date in Test Center: (Must allow 48 business hours in advance):

* Requested Exam Time in Test Center:
— Select One —8:00am8:30am9:00am9:30am10:00am10:30am11:00am11:30am12:00pm12:30pm1:00pm1:30pm2:00pm2:30pm3:00pm3:30pm4:00pm4:30pm5:00pm5:30pm6:00pm6:30pm7:00pm7:30pm8:00pm to — Select One —8:00am8:30am9:00am9:30am10:00am10:30am11:00am11:30am12:00pm12:30pm1:00pm1:30pm2:00pm2:30pm3:00pm3:30pm4:00pm4:30pm5:00pm5:30pm6:00pm6:30pm7:00pm7:30pm8:00pm
*Do you need a computer or technology for this exam?
yes
No

Will you be using a computer or technology for this exam?
I am permitted to use my own laptop for this exam
I must use a test center computer.

What format is the test?
My exam is traditional paper/pencil
My exam is administered with Honorlock
My exam is administered through ATI

*Please list accommodations you need or any other information you would like to tell us about the exam, other than extended time. Please note: exams that require a reader and/or scribe need to be requested one week in advance to allow for staff scheduling:

* I understand that the testing center utilizes video and audio recording to monitor testing and I voluntarily consent to this recording.

*Please type the word :