Off Campus STUDENT IDENTIFICATION CHECK FORM
 

Course Name:   NatSci 225 – Introductory Astronomy - Online

Institution:  Milwaukee Area Technical College - Oak Creek Campus 6665 S Howell Ave.   Oak Creek WI 53154

Instructor’s Name:   Jim Mihal

Instructor’s Cell Phone Number: (262) 751-6465

 

 

 

Student Personal Information  (student should fill out this section)

 

Student Name: _____________________________________MATC ID # :____________________________________________

 

 

Phone Number: _____________________________________E-Mail address___________________________________________________________

 

 

 It is understood that there will be no collaboration with any other individuals during this exam.   You are allowed 5 sheets (8½" x 11") of hand written notes.

 

Student’s Signature_______________________________________________________

 

 


 

Note to proctor:  The exam requires the student to use the  Respondus LockDown Browser.   Your only obligation is to do an identity check and to insure the student took the exam alone using only five 8½" x 11" sheets of hand written notes.  Please do not act as a proctor if you are a relative.

 

 

 

ID Verification Information  (Proctor fills out this section)

 

Please check that you have verification of the student identity listed above, either through a drivers license, MATC ID or some other picture ID.

 

ID Checker's Signature

 

My signature attests that I did verify the student’s identity and I am not related to the student.  I further attest that the student completed the exam using the Respondus LockDown Browser and without any help from other individuals.  Students are allowed to use five 8½" x 11" sheets of hand written notes.

 

 

Proctor Name (print or stamp) ____________________________________________________

 

 

Position or Title  _______________________________________

 

Acceptable proctors include:  Dean, Department Chair, Registrar, Professional Staff  Member of an adult/continuing education office or counseling center; Librarian, Professor, Superintendent, Principal, Guidance Counselor, Teacher, Civil Service Examiner, Notary Public, Clergy (minister, priest, rabbi, imam, etc), Military Officer,  Police Officer, Lawyer, Certified public accountant (CPA)

 

 

Address  ________________________________________________________________________________

 

 

               ________________________________________________________________________________

 

 

Phone Number: _________________________            E-Mail Address_____________________________________

 

 

 

Signature_______________________________________________________

 

 

Please keep this form and mail it using the envelope provided by the student.  Thank You.