Disability Support Services: Forms For Faculty

Faculty Alternate Testing Information Form

Please complete this form for the student with disability requesting testing accommodations(s).

Note: This form is not a certification of disability. The student should have provided you an accommodation letter from Disability Support Services. Also, the student should have discussed arrangements for this test prior to you completing this form.

Faculty Information:
Professor's Name «
E-Mail «
Phone Number «
Testing Arrangements:
Student Name «
Course and Section «
Approved Test Date «
Test Time « Time you and student have agreed for test to begin
Testing Conditions for the Class:
Time Allotted for Test « Disability Support Services will calculate extra time for students who need it. To do this, we must know the amount of time THE CLASS will have to complete the test. Check only one.	50 Minutes 75 Minutes 150 Minutes Other
Approved Test Aids for THE CLASS « Check all that apply.	Notes Open Book Calculator Other None
If You Checked Other, Please Specify
Test Delivery « Check only one.	Professor (or designee) will deliver exam to the Jenkins Study. Professor (or designee) will fax exam to (410) 617-2080. Professor (or designee) will e-mail exam to testingrooms@loyola.edu.
Test Return « Check only one.	Professor (or designee) will pick up exam from the Jenkins Study. Disability Support Services will return the exam to (see below):
Name
Building and Room Number
Test or Exam Time with Extra Time (to be completed by Accommodation Coordinator) If student receives extra time, Disability Support Services will complete this section
Time Test Started and Ended (to be completed by Test Proctor)
Fields marked with "«" are required.