Request for Test Accommodations

Please fill out this online test request form only if your instructor cannot make test arrangements and prefers you to go through Disability Resources for testing.

We require 5 business days notice for all non-final tests and quizzes.

Fields marked with an asterisk (*) are required.

Accommodations Status I have spoken to my instructor and he/she has directed me to set up test accommodations through Disability Resources

Yes
No

Student Information *Student First Name:
*Student Last Name:
*Student Phone Number: - -
*Student E-mail:

Assigned staff member:

Course/Instructor Information *Instructor First Name:
*Instructor Last Name:
*Course Number:
Instructor Phone Number: - -
*Instructor Email:

Test Information *Date class takes test
*Start Time:
*End Time:
*Room Number:

Date student takes test:
Test Start Time:
Test End Time:
Room Number:

Select your Accommodations Check all that apply

Proctor
Reader
Scribe
Taped Exam
Reduced Disrtaction Room
Extended Time
Allowed extended time from:
Allowed extended time to:

Other accommodations:

Additional Comments
Your comments:

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Request for Test Accommodations

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