ACCESS SPECIAL ACCOMODATION
TESTING REQUEST
Instructions:
- Contact the Director of Testing Services at ext. 74233 to schedule a testing date and time.
- Complete this form and attach it to any testing materials.
- Deliver all testing materials to the Testing Department, Room 1303 at least 48 hours prior to the scheduled testing date and time
DO NOT SEND THE TEST WITH THE STUDENT
Students Name (Print): ____________________________ Student #: _______________
Date/Time test is to be administered: Date: ________________________________________
Time: _______________________________________
Time Allotted: ________________________________
Please check:
Closed book Open Book Calculator No Calculator Scrap Paper
Specific Instructions or conditions not printed on this test:
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Instructors Name (Print): _________________________________ Date: _________________
Instructors Phone: _______________________________________ Office #: ______________
(This section is to be completed by the Testing Department)
Start Time: ______________________ End Time: ___________________________________
Test was administered by: _______________________________________________________
Test was picked up by: ________________________________ Date: ____________________
Faculty signature upon pick up: ___________________________________________________
