ADA Special Accommodation Request

ADA Special Accommodation Request
This form must be signed and submitted by the institution.

Please allow 5 business days for the request to be processed. There is no guarantee for a request submitted less than 5 business days from the desired testing date.

Any request submitted by a student, with or without an administrator's signature will be disregarded with no further notice.
Is this for an in-person or remote exam?*

In-PersonRemote * Proctor360
*A student requiring an exam be paused /resumed will be required to test at the school with an on-site proctor to manually control the exam.

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Student should follow your institution's directions for creating an account on the new testing portal and purchase the required exam.

Special Accommodation Request
Please select all that apply:*

Special seating or other physical accommodations (provided onsite at the testing center's discretion)Reader (provided remotely or with the testing center's discretion)Separate testing area (requires remotely or provided at the testing center's discretion)Extended Time (select time to allow)3.0 Time2.0 Time1.5 Time (Default Extension Time)Other*
*If Other, please list accommodation:

Exam Information
Exam Name*
By signing below, I confirm the individual meets the established ADA guidelines and the named institution is willing to provide requested services.
School Administrator Signature*

Clear
Date/Time*
Should be Empty: