ESOL Exam Scheduling Request

ESOL Exam Scheduling Request
If you need to schedule an exam, please complete the form below by filling in all the fields and then submit.

Once you have submitted the form, an email will be sent to your professor as well as Disability Support Services. Please make sure the information is accurate. For example, if the faculty email is not correct, the form will not be sent.

*This form is only to be used if you are a student whose primary language is not English.

*Your exam is not scheduled until you receive a confirmation email from Disability Support Services.
Student Name

First NameLast Name
Student Phone Number
(###) ###-####
Student Email Address
example@example.com
Date/time of in-class exam

MonthDayYearHourMinutesAM/PM Option
Requested date/time to take exam*

MonthDayYearHourMinutesAM/PM Option
* Note: exams need to be scheduled 48 hours in advance using this form. If it's less than 48 hours, please visit our office.
If you are requesting to take the exam at a different time than administered in class, please provide an explanation.
Course Title
ex: PSY 101
Section
Instructor Name

First NameLast Name
Instructor Email
example@example.com
Should be Empty: