TESTING SERVICES REQUEST
Student Name
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Best Contact for Immediate Assistance
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Faculty Name
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Course
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Test Type
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Please Select
Paper
Online
Deadline for test to be taken:
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Month
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Day
Year
Date
Standard time allotted for test:
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How much additional time is allotted for accommodations?
None
x1.5
x2
PLEASE CHECK THE APPROPRIATE BOX(ES) FOR ANY OPTION THAT APPLIES TO THIS STUDENT ON THIS TEST:
Open notes
Open Book
Basic calculator allowed
Scientific calculator allowed
Graphing calculator allowed
Scantron test
Essay responses may be typed in MS Word
Screen reader program (please include MS Word copy of test)
Scribe
Other Instructions (access code, dictionary use, etc.):
Attach test if needed
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