rev 9/18
Disabled Students Programs & Services
Test Accommodation Form
(Must have an approved and up-to-date Accommodations checklist on file)
mins
@
Fall
S
pring
Summer
20
INSTRUCTIONS: Student must complete Part A, then instructor completes Part B. Once completed,
deliver to Testing Coordinator or email accomdesk@bakersfieldcollege.edu to schedule a testing
appointment. Appointments must be scheduled at least three (3) days before the in-class test date.
PART A: STUDENT RESPONSIBILITY
NOTE: This form must be completed prior to scheduling your testing appointment. NO EXCEPTIONS!
*(asterisk) indicates required field. Form will not be accepted with incomplete required fields.
Student Name*:
Student ID*:
Phone:
E-mail*:
Instructor:
Course:
Class day(s) and time:
Location:
Testing Coordinator*:
Is Alternate Media Required?*
Yes No
If yes is marked, student must ask your instructor to provide an electronic copy to katrina.marquez@bakersfieldcollege.edu
at least one (1) week before the in-class test date.
IMPORTANT: A SEPARATE FORM IS REQUIRED FOR EACH TEST. DELIVER FORM AND TEST
TO TESTING COORDINATOR AT LEAST THREE (3) DAYS BEFORE THE IN-CLASS TEST DATE.
PART B: INSTRUCTOR RESPONSIBILITY
NOTE: Provide student with the completed form. Keep a copy for your records. You may also email a
copy of this form to accomdesk@bakersfieldcollege.edu. Advise student to make their testing
appointment at least three (3) days before the in-class test date.
*(asterisk) indicates required field. Form will not be accepted with incomplete required fields.
Instructor Name*:
E-mail*:
Phone:
Office*:
Name/title of test(s):
In-class test date*:
Scheduled class time allotted for test(s):
Last date student may take test(s)*:
Signature*: Date signed:
Test Delivery Method*
Instructor will deliver
to Testing Coordinator (approximate day and time):
Instructor
w
ill
s
end via email
t
o
accomdesk@bak
ersfieldcollege.edu
(include
l
ocation
*
)
Student
w
ill
deliver
in a s
ealed envelope to Testing Coordinator
Student will access an electronic test (i.e. Canvas or publisher website)
Exam
A
ids
*
Please
c
heck
if appropriate:
closed book
closed note Other Special Instructions (see below)
Special instructions:
Test Return Method*
Return in campus mail (Panorama/Delano)
Student to return (Not to be held overnight)
Scan and Email to Instructor
Instructor/designee will pick up:
(Name of designee)
Office Use Only
Test Received: Test Completed: Returned By: Date:
https://www.bakersfieldcollege.edu/dsps/testing-accomm
odations
