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

* Exam need to be scheduled 72-hours in advance using this form. If it's less than 72-hours, please visit the office to discuss scheduling options. DSS staff will make best efforts to obtain the exam in time, but you may need to schedule the exam on a different day and time. The DSS office is unable to accept same day or walk-in requests.

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