TESTING ACCOMMODATION FORM

TESTING ACCOMMODATION FORM
This form should be submitted by instructors, ONLY. Please submit this request at least 48 hours prior to the date of the test/quiz in order for the Student Success office to ensure availability of time, date, and testing method.

The new Testing Center location is the Library Computer Lab (room 234) available: Monday & Wednesday 1:00 to 3:00pm and Tuesday & Thursday 8:30 to 10:30am.
PLEASE SELECT THE BOXES THAT APPLY: *

I am requesting an ALTERNATIVE TESTING LOCATION accommodation I am requesting an EXTENDED/TESTING TIME accommodation I am requesting an ALTERNATIVE TESTING METHOD accommodation
REASON FOR REQUEST *

student has disability accommodations needed due to athletic/club responsibilities conflict make-up test
COURSE INFORMATION
Instructor Name: *

First Name Last Name
Instructor Email: *
example@example.com
Instructor Phone: *

Area Code Phone Number
Course Prefix: *
Course Title: *
Course Meeting Days/Times: *
Current Semester: *

FALL INTERTERM SPRING SUMMER
Year: *
TEST DETAILS
Test/Quiz Title: *
Number of students needing to complete test/quiz in this way: *
Student Full Name(s) - please no nicknames: *
Will the test/quiz be: *

Restricted to a singular date/time Allowed a number of dates/times options to be selected by the student A recurring series of tests/quizzes throughout the entire semester
Test Date:

Month Day Year
Date
Please indicate what time you want the student(s) to take the test OR leave blank if the student(s) can choose the time of day they plan to take the test:

: Hour Minutes AM/PM Option
Test must be completed by:

Month Day Year
Date
Indicate dates/times of tests/quizzes you are requesting: *
Method of delivery: *

Electronic Paper Oral
Details/restrictions regarding test/quiz:
use of resources, electronic access details, etc.
Please indicate the time restriction for this test/quiz in MINUTES with the slider below:
How would you like to receive the test/quiz when it is completed? *

Pick-Up Campus Mail Electronically
Do you want to upload the test/quiz to this request form for the Student Success Office?
The test/quiz should be submitted to the Student Success Office no later than 24 hours prior to the requested test/quiz date/time.

If electronically, please email the test/quiz to studentsuccess@greenville.edu.

If on paper, Student Success is located on the main floor of the Ruby E. Dare Library in Room 230.
Please upload the test(s)/quiz(zes) using the "Select Files" button below...
Should be Empty:

TESTING ACCOMMODATION FORM

COURSE INFORMATION

TEST DETAILS