Student ELC Test Accommodation Request Form
Please complete this form for each test you plan to take in the Experiential Learning Commons.  Adding your name below confirms understanding of Brevard College Honor/Academic Integrity Codes Student Affirmation:
                       
“I agree to respect the integrity, ideas, and property of the College community, fellow students, faculty, and staff, by refraining from acts such as plagiarism, cheating, theft, harassment, and abusive language or behavior. I further agree to abide by the academic policies of the institution as outlined in the College Catalog and the Social Code maintained by the Division of Campus Life and the Honor Council.”

The professor will be notified of your request and will relay approval for date/time and test details to the Office of Student Accessibility & Disability Services. ( If open notes are allowed for your test, these must be printed in advance since phones and access to the internet are not allowed during testing.)  

*Note:  The ELC Study Rooms are monitored via security camera during testing sessions.
Sign in to Google to save your progress. Learn more
Email *
Student First Name *
Student Last Name *
Course Number (Example: MAT 121-01) *
Professor's Name *
Professor's Email: *
Date you plan to take the test: *
MM
/
DD
/
YYYY
Time that you plan to take the test (remember to plan for sufficient extra time without having to miss other classes, so talk with your professor if you need to take the test at a different time from your class): *
Time
:
Are you requesting the same time and day that the class is scheduled to take the test?  (If no, please contact the professor to explain why you need to take the test at a different time. The instructor must confirm an alternate test time). *
Other Accommodation Needs (*up to 1.5 extra time in a low distraction space is automatically applied unless your accommodation plan allows more time. *If notes are approved for your test, these must be printed in advance as access to the internet or phones are not allowed).

Please review these test proctocol guidelines and check below then you have done so:

1. Take a restroom break before arriving for the test

2. Arrive for your test 5-10 minutes early.

3. Only authorized test materials are allowed in the assigned study room. The test proctor will confirm before the test what the professor states is permitted to have during the test. Leave other materials and belongings (other than a water bottle) with the proctor (including bookbags, cellphones, calculators, smart watches, headphones, notes, pencil pouches, notebooks, etc.).

 4.  Put your cell phone on silent and show the proctor where you leave it with your things in the proctor’s office.

5. The proctor monitors the test session via recording security cameras. 

6. All test materials (including any authorized scratch paper) must be returned immediately following the test.

7. Notify the test proctor if you have an emergency and need to leave the testing room.

8 If you have a question about the test that you want to ask the professor, notify the proctor. The proctor will contact the professor for clarification.

 *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Brevard College.

Does this form look suspicious? Report

Google Forms