Office for Disability Services
Fidel Center Room, 154
Student Responsibilities
Complete this section.
Work with instructor to determine test date and start time
- You must enter a specific date and timedo not write “anytime”
Return this form to the ODS office at least two days prior to scheduled test date. •
Show up at your scheduled time to take the exam.
- If you are more than 15 minutes late, you will not be allowed to test. Call the office at 835-6209
• Any changes to test date/time must be made at least one day prior to test.
- You are responsible for confirming rescheduled time with instructor.
Student name: _______________________________________
Student phone:
By signing you agree you have received and understand the
Exam/Test Request form instructions
Student signature: ___________________________________
Student e-mail:
Instructor Responsibilities
Complete this section.
Work with student to determine test date and start time
Enter regular exam length and other exam parameters.
• Deliver exam to the ODS office at least one day prior to scheduled exam via e-mail or hand-delivery
(do not send via examinee).
Completed exams will be returned within two business days unless the instructor has left other instructions .
- Please ensure you write in how it may be returned (in person, secretary, campus mail, fax, etc.).
Instructor name: _____________________________________
Today’s date:
Name/place to return completed exam: ___________________
Return exams via:
Instructor signature:
Exam details
Exam date:
Instructors phone: __________________________________
Regular exam length (minutes):
Exam time
(allow enough time to be completed before 5 p.m.):_________________ Student has: 3x 2x 1.5 times for exams
Permitted testing aids (please check):
Open notes Open book Calculator Formula sheet
OCDS Staff Only:
Initials: _______ Date form received ___________ Initials: ______ Date exam received ______________
Initials: _______ Time exam started ____________ Initials: ______ Time exam stopped ______________
Initials: _______ Date/Time exam returned ____________________________________________________
Receiver’s signature: __________________________ Receiver’s name: ___________________________
click to sign
click to edit
click to sign
click to edit
click to sign
click to edit
Office for Disability Services
Fidel Center Room, 154
Student is responsible for:
Find the Exam/Test Request Form at ODS Fidel Center 154 or website
• Completing the student section of the form.
Working with the instructor to set up a test date and time.
- A specific time must be written down so that ODS can schedule the student in.
- The exam must be scheduled early enough so the student can have full time to complete the exam
before 5 p.m. Therefore, if the exam is 60 minutes long, and the student has double time, then the
exam must start before 3 p.m.
Taking the exam at the scheduled time.
- After 15 minutes of schedule start time, if student has not arrived, exam will be returned to instructor.
- If student is running a few minutes late, the student must call the office at 835-6209.
• If exam must be rescheduled, the student is responsible for confirming new exam date/time with instructor
before calling the office to reschedule.
• Leaving all non-exam materials outside the exam room (eg: books, cell phones, backpacks).
• Complying with the University’s honor code.
The instructor is responsible for:
Working with the student to schedule a date and time.
Entering the exam time limit: how many minutes are you giving all the students to complete the exam?
ODS office will calculate out any extended time–as described in the Accommodations Form.
Entering other exam parameters (test aides or other special instructions).
• Completing the instructor section of the Exam/Test Request Form. You may ask the student to complete all but
the signature of this section. (For your convenience the exam/test request form is on our website on top).
• Getting exam materials to the ODS at least one day before the scheduled exam date. Exams may be:
- E-mailed to
- Hand-delivered to ODSplease do not send exam with student
Listing any special examination aids students may use (calculators, books, notes, etc).
Office of Counseling & Disability Services is responsible for:
Providing exam accommodations (ODS will calculate any extended time).
• Administering the exam on the scheduled date and time.
Proctoring/monitoring students.
Returning completed exams to instructor within two business days of completion–unless instructor
requests that the exam be picked-up.
• Shredding exams not taken by the student two weeks after the test date.