Student Disability Resource Center

Student Test Accommodation Instruction Form

(To be completed by Instructor)

Year: 20 Semester: Fall Spring Summer

Student's First name:

Student's Last name:

Instructor's Name:

Instructor's Email:

Phone Number:

Building/Room:

You can submit more than one date/time in conjunction with class syllabus.

Scheduled Test Date 1: Test Time 1:

Pick up test 1 date/time:

Scheduled Test Date 2: Test Time 2:

Pick up test 2 date/time:

Scheduled Test Date 3: Test Time 3:

Pick up test 3 date/time:

Scheduled Test Date 4: Test Time 4:

Pick up test 4 date/time:

Student can take test (check box for yes):

Different Day :
Different Time:

SDRC will receive the test by (check only one box):

Test will be emailed to SDRC@uwf.edu:
Test will be delivered to SDRC:
Test will need to be picked up by SDRC:
Test will be brought by student:

SDRC will deliver the completed or incomplete test by (check only one box):

Test will be emailed back to instructor:
Test will be delivered by SDRC to instructor or department secretary:
Test will be picked up at SDRC by instructor:
Test will be faxed to number listed in Other Instructions and hard copy placed in Campus Mail:
Completed test will be delivered by student:

Student can use the following items during the test (check all that apply):

Open Book

Open Notes

Calculator

Dictionary

Laptop:

Other Instructions: