Test Accommodation Request Form

Requests should be submitted 5 business days prior to the intended test date


Section 1 - Student Information
Name
E-Mail
Phone
College
Section 2 - Professor Information
Name
E-Mail
Phone
Section 3 - Course Information
Title
Section 4 - Test Information and Instructions
Date of Test
Start Time
Time Allotted for the Class
How will the test be delivered to the Academic Support Center?
Instructions for returning the exam to the professor
Note: If any student is late, cancels, or otherwise misses his or her scheduled exam, he or she must contact their Professor/Instructor, the Office of Disabilities Services, and submit another Request Form (if necessary)
Section 5 - Accomodations Required
Check all that apply

Extended Time x 1.5

Extended Time x 2

Reader (assigned by Academic Support Center)

Scribe

Computer

Testing Space Only