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
Instructor’s 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)

 

PLEASE FILL OUT YOUR SPECIAL INSTRUCTIONS FOR THIS PARTICULAR STUDENT:

 

 

Finish by this date/time:

 

Method of   Exam Delivery:     E-mailed to the City Park Testing Center at cityparktesting@dcc.edu

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

 

 

 

Method of   Exam Return:     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 (01/15)

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