Disability Support Services: Forms For Students

INSTRUCTIONS:

1. Requests must be submitted one week in advance.
2. Speak to your instructor before submitting this form. Agree on a date and time to take the exam, remembering DSS will proctor between the starting time of 9:00 am and ending time 5:00 pm, Monday through Thursday. The ending time on Friday is 4:00 pm.
3. Please provide all information requested on this form and submit.
4. Once all information is received, a confirmation e-mail will be sent.
5. If you have any questions, please contact DSS at testingrooms@loyola.edu or call (410) 617-2750.

Student Alternate Testing Request Form

Student / Course Information:
Name «
E-Mail «
Phone «
Course Title «
Department «
Course Number «
Section «
Professor / Test Information:
Professor's Name «
Professor's E-Mail «
Professor's Phone «
Please Read «	By checking this box, I confirm I have discussed accommodations with the abovementioned faculty member for the test requested below. I confirm the professor has agreed to the date and time I have indicated below.
Test Date «
Start Time «
Accommodations Required « Check all that apply.	Extended Time Reader Scribe Computer Adaptive Technology
Note to Professor Optional.
Please Read «	By checking this box, I confirm that I have met with and provided this faculty member with written notification of my eligibility for Disability Support Services.
Fields marked with "«" are required.