Accommodated Testing Form

Accommodated Testing Form
Location: Learning Commons Room 118 Phone: 719-384-6963 Email: frida.beyerl@otero.edu
Please complete and submit the Accommodated Testing JotForm with the test as soon as possible or no later than a week prior to the test date. Instructors may also email or drop of the test with Accessibility Services.
To Be Filled Out By the Student

Please fill this form and submit it a week before your exam.
Student Name *
Student Name
S# *
S#
Course *
Course
Instructor *
Instructor
Testing Appointment Date *

Month Day Year
Date
Test Appointment Time *

Hour Minutes

AM/PM Option
Instructor's Email *
example@example.com
To Be Filled Out By the Instructor

Pleas have this form completed and submited to Accessibility Service no later than 24 hours prior to the exam.
Instructor preferred contact information including cell number
Calculator Type

Basic: Scientific: Programable Other
Testing instructions
How much time is the class allowed?
Testing Deadline
Testing Deadline
*Instructors are responsible for picking up completed tests from the Accessibility Services Specialist.
Instructor's Initials
Initials
Date

Month Day Year
Date
Accessibility Service Specialist Use Only
Accessibility Service Test Time
Testing Time
Start Time
Start Time
End Time
End Time
Faculty Pick Up initials and date

Month Day Year
Date
Accessibility Specialist Signature

Clear
Should be Empty: