Makeup Exam Request
Please complete this form and submit it to the Disability Support Services Office along with the exam to be made up, at least 72 hours prior to the time that you would like the exam administered. Make-up exams may need to be scheduled during evening hours due to high volume of registered DSS students taking exams during the day. NOTE- Confirm with the student a SPECIFIC DAY/TIME for the exam, before submitting the request.
Instructor
First Name
Last Name
Instructor Email
example@example.com
Course
ex: PSC-101
Student Name
First Name
Last Name
Student Email
example@example.com
Date for Exam
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Time Allowed
Check applicable items allowed to student during the exam:
Notes
Open Book
Calculator
Dictionary
Scrap Paper (returned with exam)
Scrap Paper (not returned)
Technology Needed
Canvas
Excel
Word Processor
Other
How can we reach you during the exam?
Other Special Instructions
Options for delivering exam to Disability Support Services (first floor library):
E-mail (DSS@lemoyne.edu)
Professor will hand deliver the exam to DSS
Canvas/Online Access Code (please provide below)
Please Provide Canvas/Online Access Code
Exam Return: Check your preference:
The Proctor will return the exam via campus mail
The Proctor will return the exam via e-mail (Scanned to a PDF)
Online/Canvas test
Student will return the exam to the professor (least preferred; occasionally appropriate)
Professor will pick up completed exam at DSS
Submit
Should be Empty: