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.