Request must be filled out entir

Request must be filled out entirely

Center for Student Progress Disability Services
Test Request Form

 
Professor's E-mail    Date of Request
Student Name          Student Patron I.D.  
Telephone                 
Professor's Name     Extension          
Full Class Name       Course Code Cat #
Test Given in Class:  Day Date Time: (From) (To)

** Accommodations Needed  

When I need to take the test at CSP Disability Services:
Day    Date   Time: (From)   (To)

If scheduled different from class time--why? 
(Professor must call the office to give permission for a different time.)

** If you do not request your needed accommodations, it may affect our ability to administer your test as scheduled.

(Office Use Only)

Spoke with Professor:    _______________

Professor's Voice Mail:  _______________

Message with Secretary _______________

Test Already Sent Over: ________________

Other: _______________________________