On line Test Accommodation Request Form

ONLINE Test Accommodation Request Form

Student Instructions: Please provide all information requested on this form and submit. An e-mail will be sent to the professor for approval and Testing Services Center staff will be notified of the request. Testing Center Hours: 8:00-17:30-Mon-Thurs 8:00-13:30 -Friday Requested start times: 8:00 am = 8:00 9:00 am = 9:00 10:00 am = 10:00 11:00 am = 11:00 12:00 pm = 12:00 1:00 pm = 13:00 2:00 pm = 14:00 3:00 pm = 15:00 4:00 pm = 16:00 5:00 pm = 17:00 If you have any questions, please contact jtrageser@towson.edu Submit requests at least 5 days in advance of test date. DSS is currently accepting requests for tests on or after the following date: 2/17/2012	Student & Course Information:	Professor & Test Request Information:
	Name*	Name*
	E-mail*	E-mail*
	Phone*	Phone*
	Course Title	Test Date*
	Department*	Test Date*
	Course Number	Start Time*	:
	Section	Accommodations	Extended Time
			Reader
			Scribe
			Computer
			Assistive Technology
			Minimal Distraction Space
		Note to Professor (optional):

		By checking this box I confirm that I have provided the faculty member with my Disability Support Services memo authorizing my accommodations.

	© 2012 • Towson University	Last Updated: Tuesday, January 25, 2011
	Towson University • 8000 York Road • Towson, Maryland • 21252-0001 • 410-704-2000	Copyright Information \| Privacy Statement \| Clery Report \| Contact Us