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.
STUDENT ACCOMMODATIONS
Must be submitted to Assistant to the Dean one (1) week in advance.
| ________________________________ | ________________________________ |
| Student’s Name | Date |
| ________________________________ | ________________________________ |
| Instructor | Course |
| ________________________________ | ________________________________ |
| 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 |