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Test Request Form

Student's E-mail    Professor's E-mail 

Student's Name     Date of Request 


Student's ID#    Telephone 


Professor's Name    Ext. 

Full Class Name    Course Code    CRN # 

Test Given in Class:  DAY    DATE    TIME:   FROM   TO


** Accommodations Needed:



WHEN I NEED TO TAKE THE TEST AT CSP DISABILITY SERVICES:


DAY     DATE    TIME:  FROM     TO 


 
If scheduled different from class time, why?  


(Must have Professor's signature or s/he must call the office to give permission.)


** If you do not request your needed accommodations, it may affect our ability to administer your test as scheduled.

 

Rev. 08/09

 
AllofE Solutions