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DISABILITY SERVICES

Test Request Form

Name:

Phone Number:

Class (like Soc 111):

Instructor:

Date to take the test (Please give 3 days' notice; this does NOT include Saturday & Sunday):

Start time for test:

Will the class take the test on the same date you've requested above?

Accommodations Needed for this Test/ Check all that apply!

Extended Time                        

Proctor (Reader/Writer)

Braille

Enlarged Test

Private Room

Computer

Visual Tech

Color Paper

 

Your E-mail Address: