Testing Accommodation Form
STUDENT ACCESSIBILITY RESOURCE CENTER
1906 College Heights Blvd #21052, DSU 1074
Bowling Green, KY 42101-1052
Phone: (270) 745-5004 • Fax: (270) 745-6289 • TTY: (270) 745-3030 • Video Phone: (270) 288-0597
Email:
STUDENT:Please fill out your information and provide to the instructor after mutually discussing the arrangements for the exam.
Student's Name ______WKU ID # ______
Course ______Instructor's Name ______
Requested Date and Time to take Exam: ______
INSTRUCTOR:
Please fill out the remaining information and return to SARC with the Exam attached. The paperwork can be delivered via email, fax, or hand delivered. We do not recommend campus mail for confidentiality reasons. For those same reasons, please do not write the student’s name on the outside of the envelope.
Please provide SARC the best way to contact you if we have questions administering the exam.
(Phone or email is acceptable): ______
Please check allowed test materials.
______Blue/Green book ___Calculator (specify type) ______
______Extra paper ___Scranton (Specify type) ______
______Statistical tables ___ Textbooks (specify) ______
______Map __ Notes/Other (specify) ______
When is exam(s) scheduled for the entire class? ______
How long does the class have to take exam(s)? ______
In the event that an exam cannot be scheduled during the class’s originally scheduled date and time, the exam must be administered within ______school days of the original exam.
Exams must be delivered to the SARC office no later than noon the day before the scheduled exam with attached Exam Instructions. Please check which method we can expect to receive the exam.
______Hand delivered to DSU 1074 ______Emailed to ______Faxed to 270-745-6289
An email will be sent no later than the afternoon before each scheduled exam to confirm receipt of exam.
Instructor's Signature ______Date ______
SARC Office Use OnlyExam Arrival Date ______Exam Received by ______
Receipt of Completed Exam______Date ______