Texas Computer-Based Testing Collaborative (TCBTC) Request

*Required Information Form to be Completed by Faculty Member* *Indicates required fields
Student First Name
Student Last Name
Student ID Number
*Faculty First Name
*Faculty Last Name
*University
*Faculty E-mail
*Faculty Phone#
Faculty Fax #
Faculty Mailing Address
city state zip

Course Number Section
*Exam Type (Midterm, Final, ect)
*Exam Server URL
Testing Software (WebCT, Blackboard, etc)
Plug-ins Required? Yes No
Please list required plug-ins:
NOTE: Correct software information is critical for successful test administration
*Secondary Contact (e.g. departmental)
*Secondary Phone #
*Computer Services Contact
*Computer Services Phone #
Administer this exam anytime after but before*
Allow no more than (list hours* and minutes for this exam)

Indicate yes or no below:
Yes	No
		If the student opens the testing website and does not take the test immediately, a grade of "F" will be assigned automatically.
		Be present and in view of the student throughout the exam.
		Other materials may be used (examples: notes, books, Scantron, calculator, additional URL's or Web site, Headphones). Please list permissible materials here:
		The exam may be printed.
		The student may visit URLs other than the test site.
		Password Required NOTE: If an access code or password is needed, it must be supplied to the testing center prior to the test administration date. Please contact (name of site contact) at (name of site) with this information via telephone at (site phone number) between the hours of (site hours of operation).


	Other special instructions or special accommodations required by the student or for the test (e.g. wheelchair access, etc.)

For questions or comments about TCBTC, contact:
Suzanne Gravois
817-735-2288