For which quarter is this?

• Summer
• Fall
• Winter
• Spring

In which classes would you like to receive your Testing Accommodations?

• Class #1:
• Class #2:
• Class #3:
• Class #4: 
• Class #5: 
• Class #6: 

Please give us your contact information:

Name:  *

E-mail address (from):  *

Type again to confirm e-mail (cc): *

Student I.D. Number

Phone number: 

Please check the box to indicate that you accept and understand the following:

• You need to turn this form in for every quarter you plan to receive accommodations.  If we don't know which classes you are requesting accommodations for, we will be unable to serve you.
• You must try to register as early as possible in order to select the classes that best match the needs of your accommodations.
• Try to space classes apart, allowing you to use extra test time without being late for the next class.
• You must reserve a testing room in advance so we can make sure there will be space for you.  You can reserve by e-mail, phone, or in-person.

• You must let your instructor know that you plan to take your test at Special Services, prior to each test.

• Tests need to be scheduled within 30 minutes of the class start time and on the same day as the class's test, unless the instructor permits otherwise, in writing.
• If you add, drop, or change a class, tell Special Services.
• If you need special equipment for a test (computer, large print, magnifier), let Special Services know at the time you make the reservation.

Is there anything else you would like to mention?

* Required