Test requests must be submitted at least 7 business days in advance.

Today's Date

Name Phone #

Course Professor

Class test day and date Class Test Time

If you are requesting to take the test on a different day or time, please indicate below:

Day/date Time

Delivery Arrangements

Student will pick up test in sealed envelope

Professor will deliver the test

Other

Academic Adjustments Needed- check all that apply

Reduced distraction Extended time Tape recorder Taped exam

Reader Scribe Brailled exam Exam in large print CCTV

Computer Computer with voice output

Other

Test Parameters

Expected average lenth of time class will be testing:

15-20 minutes 30 minutes 1 hour 1-1/4 hours 2 hours/final exam

Conditions set by professor* Notes allowed Open book Calculator allowed

*If any of these three conditions are checked, OSS will verbally confirm them with your professor.

Print one copy of this test request for yourself and one copy for your Professor

Please check this form before submission.

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