1. The Office of Advising and Testing
      2. DISABILITY SERVICES TESTING
      3. ACCOMMODATIONS FORM
      4. This form must accompany all tests to be given in the
      5. Special Populations Testing Area (City Park Campus, Building 2, Room 302)


The Office of Advising and Testing


DISABILITY SERVICES TESTING


ACCOMMODATIONS FORM

 


This form must accompany all tests to be given in the


Special Populations Testing Area (City Park Campus, Building 2, Room 302)

 

 

Student’s Name      Student ID Number
Instructor’s Name     
Building #/Room#     
Instructor’s Phone     
Course Prefix/Section Number

AIDS ALLOWED: No aids will be permitted unless specifically authorized.

  Calculator          Dictionary        Scantron 882E/ES (green,1-100,A-E)

 

  Notes     Translation Device/Book         Scantron 2052 (blue, 1-100, 1-5)

 

  Note card   3”X 5”   4”X 6”      Blue Book   Scantron F-165(red, 1-100, A-E)

                            5”X 7”                   

  NCS ScanForm 19641                     Other

 

  Textbook          Scantron 881E/ES (green, 1-50, A-E)

 

SPECIAL INSTRUCTIONS:

 

 

Finish by this date/time:

 

Method of   Exam Delivery:     E-mailed to cityparktesting@dcc.edu

  Hand-delivered to Testing Center (Bldg. 2 Room #302) by Instructor

 

 

 

Method of   Exam Return:     Completed test will be scanned and sent to instructor’s email address

  Instructor will   pick up exam from Bldg. 2 Room #302  

          Testing Center will return test to

       

 

Instructor’s Signature                Today’s Date

                   Form 1468/002 (2/13)

Back to top

Page 1 of 1