Student Alternate Testing Request

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Home > Campus Life > Health Services > Disability Support Services > forms > Student Alternate Testing Request

Disability Support Services: Forms For Students

INSTRUCTIONS:

Requests must be submitted one week in advance.
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.
Please provide all information requested on this form and submit.
Once all information is received, a confirmation e-mail will be sent.
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.