ACADEMIC SUCCESS CENTER REQUEST FOR TESTING ACCOMMODATIONS
To Be Completed By Student
1) The student will meet with the professor to explain the need for testing accommodations and
verify that documentation is on file with the ASC to validate the accommodations.
2) The student will then return the completed form to the ASC to schedule the test.
Student’s name: Student’s phone:
Professor’s name: Course number:
Example: Prof. Smith Psy 100
Classroom test time is: (We want to know how much time the class gets; we’ll calculate your extended time.)
Day: Date: Time: Length:
(Students must schedule their exam to coincide with their class. In the event that a student’s class
schedule prohibits an extension of the testing period, the ASC will work with the student to find an
alternate testing time that same day.)
Testing accommodations: ⃝ Quiet Setting ⃝ Scribe ⃝ Laptop
(
Please check all that apply) ⃝ Extended Time ⃝ Reader ⃝ Other:
Student: Please return this form to the ASC at least
3 business days
prior to test.
If the test is on , pink sheet is due to the ASC on .
Monday ….................................................................... Wednesday
Tuesday ….................................................................... Thursday
Wednesday ….............................................................. Friday
Thursday ….................................................................. Monday
Friday …....................................................................... Tuesday
To Be Completed By Professor
1) The professor will note any special testing instructions below and sign the form. The
professor will receive an email confirming that the test has been scheduled. This email will
also serve as a reminder to deliver the test to the ASC.
2) The ASC staff will hand deliver the completed test to the department for a signature verifying
receipt within 1 business day of completion. Professors are also welcome to pick up the
completed test from the ASC at their convenience.
Special instructions the ASC staff should know when administering the test:
Example: 1 sheet of notes & calculator allowed, needs computer, scantron needed
*Scantrons & bluebooks must be provided by the professor
Signature of Professor:
Cell Phone # (or way to contact if student has questions):
Professor: Please send test to the ASC in person or electronically to asctests@hope.edu
For ASC Office Use Only
Test is scheduled:
Day: Date: Time: Length:
Initials:
