OMR SERVICE FORM

User Name		Computer Center Acct#
User ID		Phone#
Alternate's Name		Department
Instructor		Building

If your Building is a courier drop, do you want courier delivery?
Yes       No

CST Test/Survey			If Forms are Rejected?
TEST			Do not print reports
Weight#			Produce reports anyway

Scanner Program Name:

By signing this form, you are authorizing the alternate (if specified) to pick up these OMRs or have them delivered to the courier drop in your building. Once the OMRs are picked up or delivered, the Computer Center is no longer responsible for this data.

Signature:

Date:

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OMR OFFICE USE

OMR Batch#		Date:		Inititals:
Rejected Forms:		Accepted Forms:		Date:
Jobname:		Job Number
Billed:		Inititals:		Date:

OMR PICKUP:
Note: When picking up OMRs, picture ID is required. Without proper ID, OMRS will not be issued to anyone.

Pickup Signature:

Date:

Helpdesk Initital: