Exam Accommodation Form

First Name * Please enter your first name. Last Name * Please enter your last name. Email * Please enter an email. Invalid email. Confirm Email * Please enter an email. The emails don't match.

Course Number * Please enter a course number. Instructor Name * Please enter a name. Instructor Email * Please enter an email.

Date you are taking exam * Time you are taking exam * Please enter a time.

Are you taking the exam close to the same time as the class? Yes No

If no, please explain why below.

Please choose only accommodations you are approved for

Extra Time Separate Location Calculator Text-to-Speech (Exam Reader Software) Speech-to-Text (Assistive Typing) Type Exam I will need to use a SAS computer Other

Additional Comments

If problems or questions arise, please provide us with the best telephone number where we can reach you.

Phone *

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