Accommodative Testing Appointment Form

      Note: all fields are required.

      This online form is for students who want to make an appointment to take a test or quiz with accommodations such as extended time, computerized reader, etc. If you submit this form 3 business days or less prior to your desired appointment date, please contact your instructor directly to make sure that s/he will be able to send a copy of your exam.

       First Name:


      Last Name:


      Email Address:


      Phone Number:


      Student ID:


      Course Name (the test is in):


      Course Instructor:


      Date of Test:   [None] Select a Date Delete the Date

      Time of Test:

      Location of Test:

        

      Accommodations Needed: (enter none if no accommodations are needed)


      Preferred means to contact you.