Sample Form for Remark Office OMR®

This is a sample form to illustrate the features of the Remark Office OMR software by Gravic, Inc. The form could
represent either a simple survey, such as a course evaluation form, or could be used for a multiple choice test
application. The form has 3 regions that can be processed, the Teacher Name (a barcode), the Student ID Number
(a 3-digit numeric Grid field), and the Multiple Choice items (a 25 item Multiple Choice field). Note that this form is for
illustration only and you are not limited to these types of regions or the format of this form.
______________________________________________________________________
GENERAL INFORMATION:

Name: ____________________ Student ID Number:

Instructor Name: __ 

__ 

*Dr!Smith* __ 

Please mark the correct answer to each of the questions by completely darkening the oval of your choice
with a dark pen or pencil. Be sure to enter your name and student ID number before beginning the
exam.

MULTIPLE CHOICE: A B C D E

1. Sample question text for question #1 O O O O O

2. Sample question text for question #2 O O O O O
3. Sample question text for question #3 O O O O O
4. Sample question text for question #4 O O O O O
5. Sample question text for question #5 O O O O O
6. Sample question text for question #6 O O O O O
7. Sample question text for question #7 O O O O O
8. Sample question text for question #8 O O O O O
9. Sample question text for question #9
O O O O O
Note: Spacing does not have to be consistent!
10. Sample question text for question #10 O O O O O
11. Sample question text for question #11 O O O O O
12. Sample question text for question #12 O O O O O
13. Sample question text for question #13 O O O O O
14. Sample question text for question #14 O O O O O
15. Sample question text for question #15 O O O O O
16. Sample question text for question #16 O O O O O
17. Sample question text for question #17 O O O O O
18. Sample question text for question #18 O O O O O
19. Sample question text for question #19 O O O O O
20. Sample question text for question #20 O O O O O
21. Sample question text for question #21 O O O O O
22. Sample question text for question #22 O O O O O
23. Sample question text for question #23 O O O O O
24. Sample question text for question #24 O O O O O
25. Sample question text for question #25 O O O O O

This form is a sample form for use with Remark Office OMR®. For more info visit: www.gravic.com/remark
Copyright © 2010, Gravic, Inc. This form has been provided as an example only. You are free to modify this form for your usage.
Gravic makes no express or implied warranty that this document will be fit for a particular purpose.