Test Request Form

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Test Request Form

This form is used to request tests for students with academic accommodations.

Student ID

Last Name:

Mobile Number:

First Name:

Course Number (Ex: ENG 1110)

Course Name (Composition I)

Date you will take the exam/quiz in the Accessibility Services Office:

YYYY

Time you will take the exam/quiz in the Accessibility Services Office:

Time

Requested Accommodations (requests will be verified by your accessibility services file.)

Time and a half

Untimed

Scribe

Reduced Distraction Environment

Test reader

Use of a calculator

Other

Clear selection

Please explain any other information you would like the proctor to know before the test/quiz:

Are you resubmitting this form to change the date/time for a test you requested previously.

Yes

Clear selection

Submit

Clear form

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