Exam Accommodation Form Request

SDS needs at least 14 days advance notice in
order to process exam accommodation requests. Exam accommodations requested with less than 14 day notice will not be guaranteed. [Keep in mind that SDS requires a signed and dated Course Roster Form before beginning the process of arranging exam accommodations]

Name:

Email Address:

Telephone Number:

( ) -

Course:
(Name & Number ex. HIST 001-002)

Graduate

Undergraduate

Instructor

Name:

Email Address:

Telephone Number:

( ) -

Teaching Assistant

Name:

Telephone Number:

( ) -

Email Address:

Exam Details

Exam Date:

Original Exam Time (ie. 5:00pm-7:00pm):

Accommodated Exam Time:
(ie. 5:00pm-9:00pm):

Original Exam Location

Accommodations Requested:

Extended Time (Time and a half)

Extended Time (Double Time)

Alternate Exam Site

Proctor

Scribe

Lap top use

Other

Exam Instructions

Check ALL that apply:

notes allowed

open book

calculator

Other

Additional Comments (optional):

Visit the Vice Provost for University Life website