QCC OFFICE OF ACCESSIBILITY (OAS)  Testing/Exam Accommodation Form                  THIS FORM SHOULD ONLY BE USED IF YOU HAD A PROBLEM FILLING OUT A BOOKING REQUEST ON ACCOMMODATE.
THIS FORM SHOULD ONLY BE USED IF YOU HAD A PROBLEM FILLING OUT A BOOKING REQUEST ON ACCOMMODATE.  Please fill out this form completely to request exam accommodations at least 2 BUSINESS days (Monday - Friday) prior to your scheduled exam in order to guarantee accommodations. Fields with an * are required. In person on campus exams will be held in the Accessibility Lab located in L116 based upon space availability.  PLEASE NOTE: You must fill out a Semester Request on Accommodate.
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Student Name (Please enter Your First and Last Name) *
QCC Student ID Number (8 digits) - located on your QCC ID Card   *
Student Phone Number (please enter your phone number) *
QCC Student email *
Your email address will be your CUNYfirst login user name followed by @stu-mail.qcc.cuny.edu. Your CUNYfirst login user name is FirstName.LastName and the last 2 digits of your student ID number which is located on your TigerCard.  For example "Joe.Smith11"
Course Number (the course number is 2-4 letters and 3 digits, ex. MA 119 or PSYC 101) *
Section Number - the section number is 3-4 digits after the course number ex. MA 119-E324 - the Section Number is E324 *
PROFESSOR Name (First Initial, Last Name) *
Is this exam online or in person on campus? In person on campus exams will be held in L116 based on space availability.
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Date of Exam (the actual date the class is taking the exam) *
MM
/
DD
/
YYYY
Time of Exam  (the actual time the class is taking the exam)
Time
:
Do you know how long the class will be given for this exam - Enter Hours and Minutes  (Please note that OAS Staff will extend this time accordingly and confirm with your professor)
Hrs
:
Min
:
Sec
Accommodation(s) Requested for this Exam - Please enter any ADDITIONAL OAS Accommodation(s) Requested for this Exam - Please enter any ADDITIONAL  approved accommodations you are requesting for this exam under Other. *
Required
Do you have a time conflict - will your extended time run into another class? If you answer yes you will be contacted by OAS Lab staff. *
Do you need assistance filling out this form or have questions about how to take your exam? If you answer yes, you will be contacted by OAS  Lab staff within 24-48 hours. *
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