Testing Accommodation Request Form
Request to use accommodation(s) in the Assessment Center.
I have previously been granted special testing accommodations with Brazosport College:
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Yes
No
Student Information
BCID number:
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Date of Birth
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Month
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Day
Year
Date
Name
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First Name
Middle Name
Last Name
Email
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The e-mail address for your BC Student email account is your username@brazosport.edu
Daytime Phone Number
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Evening Phone Number
Test Information
Test I am requesting accommodations for:
TSIA2
HESI
Credit by Exam
CLEP
Test date for which special accommodations are being requested:
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Month
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Day
Year
Date
If TSIA2, please indicate the subjects you will be taking.
ELAR (Reading & Writing)
Math
Retest Essay Only (Retesting only available once deemed College-Ready via the TSIA 2.0 ELAR multiple-choice exam)
Retest ELAR Multiple-Choice Only (No Essay, Retesting only available once deemed College-Ready via the TSI/TSIA 2.0 Essay)
List the specific testing accommodation(s) requested:
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Additional Time
Allow extra breaks as needed for food and/or medication
Allow medical device(s) in test room
Oral (Read to Student)
Test in private area
Test each subject individually
Use Color Overlays (Student must provide.)
Use of Green Overlay (Student must provide.)
Voice-to-Text Software
ELAR Test Date:
Math Test Date:
Retest Essay Only Test Date:
Retest ELAR Multiple-Choice Only Test Date:
If any or all special accommodations I am requesting are denied, I would like to be registered under standard conditions.
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Yes
No
Student Certification
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By checking this box, I certify that I am the person whose name and address appear on this form. I am submitting, together with this completed Testing Accommodations Request form, any required documentation as requested by the Counseling and Testing department. I understand and agree that the special accommodations I have requested herein will be given due consideration. If, and to the extent that, any such request is granted, I understand that I will be taking the test under special conditions.
Signature
Clear
Today's Date
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Month
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Day
Year
Date
Submit
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