Fillable Alternative Testing Request (Las Positas College)

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Alternative Testing Request (Las Positas College)

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

DisabledStudentPrograms&Services

3000CampusHillDrive|Room1615,Livermore,CA94551

(L): DSPS Data | New Forms | Final Drafts_05.28.19

ALTERNATIVETESTINGREQUEST



Faculty:PleasecompletebothsidesofthisAlternateTesting Request.



FacultyMember:_______________________________________Date:____________________

Course:________________________________________________________________________

Student:________________________________________W#10_________________________

From:TerriDannerDRCTestFacilitator,Bldg.1600Suite1615extension1523



YourstudenthasrequestedtheuseofalternativetestingthroughtheDisabilityResourceCenter.TheDRC

offersalternativetestingforeligiblestudentswithaverifieddisability.Thisserviceisprovidedtostudents

asanauxiliaryaid,whichprovidesequalaccesstoeducation,pursuanttoSection504oftheRehabilitation

Act.



Exams scheduled to be taken through the DRC are supervised by staff per each instructor’s individual

guidelines.



Yourstudenthasrequestedthefollowingmandatedaccommodationsbasedonhis/herAcademic

AccommodationPlan(AAP):



x AdditionaltimeEnlargedExam

x Undistractedexamspace  Scriber/Writer

 Reader   Kurzweil 

 Other:



ContinuetoPage2

FACULTYINSTRUCTIONS:Pleaseindicateyourallowedaccommodations:

OpenBook YES☐NO☐

OpenNotes YES☐NO☐

3x5INDEXCARDS  NO.OFCARDS_______Turnincard(s) YES☐NO☐

8x11SHEETOFPAPERNO.OFSHEETS_______TurninNoteSheet(s)YES☐NO☐

☐Calculator☐ScratchPaperTurninscratchpaperYES☐NO☐

☐Dictionary/Thesaurus ☐Useofstudent’spersonalcomputer

☐InternetAccess   ☐StudentwillneedaGreenBook

☐StudentwillneedaScantron® ☐StudentwillneedtowriteinPen____/Pencil____

☐Other:__________________________________________________________________

__________________________________________________________________

Amountofregularclasstimeallottedforexam._____________________________

 Yourexamisscheduledfor____________________at________________

Date  Time

☐DRCwillbeabletoproctortheexamatthistime

☐DRCwillbeabletoproctorexamon_________________________________________

Isthisarrangementacceptable?YES☐NO☐



DELIVERYANDRETURNOFEXAM:Pleasecheckwhereappropriate.



Delivery:☐Iwillputexaminyourcampusmailbox

 ☐IwilldelivertoDRC

 ☐StudentmaydeliverexamtotheDRC

 ☐Emailto:lpctestproctor@laspositascollege.edu(Pleaseindicatenumberofpagesforexam)

Return:☐Pleasereturntomycampusmailbox

 ☐IwillpickupexamattheDRC

☐Iwillpickupattheinformationdesk

 ☐Studentmayreturnexamtome(Room#_________)

 ☐Scan‐Emailto:________________________________________________



Emailandnumberwecanreachyouat,

ifexamhasnotbeenreceived.



FacultyEmail:________________________________FacultyPhone:______________________



FacultySignature:__________________________________Date:_________________________



PleasereturnthisformtomeassoonaspossiblesothatIcanmakeappropriatearrangementsforyour

student’sexam.Shouldyouhaveanyquestions,pleasecontactmeatextension

1523.



Thankyouforyourcontributiontoabarrier‐freeLasPositasCollege.



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Completed 26 July 2020

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