STUDENT IDENTIFICATION CHECK FORM

The final exam for this class is administered through Blackboard.  Students must have reliable internet access to successfully complete the exam.  The exam has a 2 hour time limit.

Student Personal Information  (student should fill out this section)

Student Name: _____________________________________MATC ID # :____________________________________________

Student Address___________________________________________________________________________________________

Phone Number: ____________________E-Mail address___________________________________________________________

Course Name:   NatSci 10-806-167 Science of Technology - Online   Instructor’s Name:   Jim Mihal

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

This exam is open note/book.  It is understood that there will be no collaboration with any other individuals during this exam.

Student’s Signature_______________________________________________________

Please let the MATC employee (or off campus proctor) fill out the sections below

Location of exam: 

□  South Campus ASC     □ West Campus ASC     □ North Campus ASC      □ Off Campus Proctor
 

ID Verification Information

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

□ Personal Knowledge     □  Drivers License    □  MATC ID      □ Other picture ID  ______________ 

ID Checker's Signature

My signature attests that I did verify the student’s identity.  I further attest that the student completed the exam without any help from other individuals.

Signature_______________________________________________________

If from an MATC campus  – Please mail this via  intercampus mail to  Jim Mihal (South Campus)

If off campus, fill out the lines below and mail to address indicated

Proctor Address  ________________________________________________________________

                                _______________________________________________________________

Phone Number: ____________________E-Mail Address___________________________

School or Library Name ___________________________________________________

Position or Title__________________________________________________________

Please be sure the student has an addressed envelope to the address below.  Enclose the completed Proctor Information Form in the furnished envelope.  Seal the envelope, write your name or initials across the seal and give it back to the student for mailing to their instructor.  If the student has sufficient amount of postage on the envelope, you may mail it for them.

Instructor Name:  Jim Mihal

Instructor Address:               MATC South Campus (box #206)

6665 S. Howell Ave

Oak Creek, WI 53154