It is the student's responsibility to take this form to the instructor two weeks before the test to discuss testing arrangements. Allow enough advance time for the accommodations to be arranged.
|Requested Testing Date||Time (Include extended time if applicable)|
PICK-UP - in a sealed envelope on _______________ (Date and Time):
_____ Instructor will leave test at front desk.
_____ Instructor will leave test with Diane Hansen, Coordinator of Academic Support and Disabled Student Services.
_____ Student will pick up test from instructor.
RETURN - Student will submit test in a sealed envelope:
_____ to front desk for instructor's mailbox.
_____ to Diane Hansen, Coordinator of Academic Support and Disabled Student Services.
_____ to instructor.
|Instructor Signature | phone||Student Signature | phone|
Must be submitted to Assistant to the Dean one (1) week in advance.
|_____ Computer (Specify software: ________________________________ )|
|_____ Extended time (Specify: ________ )||_____ Test taped|
|_____ Student Tutor to read test||_____ Proctor|
|_____ Writer||_____ Interpreter|
|_____ Writer||_____ Use of standard dictionary|