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SECTION 1: STUDENT SECTION: Students, please complete all (Minnesota State University, Mankato)

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132 Memorial Library • Mankato, MN 56001
507-389-2825 (Phone) • 800-627-3529 (MRS/TTY) • 507-389-1199 (Fax)
www.mnsu.edu/access
CONFIDENTIAL ALTERNATIVE TEST AGREEMENT FORM Semester:_________
SECTION 1: STUDENT SECTION: Students, please complete all of the information in this first
section and the contract on the back side only and return form to Accessibility Resources in ML 132.
Today’s Date ______________________
Name ______________________________ Local Phone _________________ Tech ID_________________
Course Dept. _________Number________Section _______Title______________________________________
Example: BIOL 101 01 General Biology
Instructor’s full name: _______________________________Lab Exams_____Yes Online exams ______ Yes
Example: Prof. Jane Doe ______No _______ No
*PLEASE REMEMBER TO TURN FORM OVER AND READ THE TESTING CONTRACT. I have read the testing
contract and will abide by the Alternative Testing procedures which have been explained to me.
Student Signature________________________________________________________________________________
SECTION 2: Accessibility Resources STAFF SECTION - Office Use Only:
This student qualifies for alternative testing because of a documented disability. Accommodations
approved through Accessibility Resources:
________Reduced distraction room
________Extended Time ______X 1.5 ______X 2 (please calibrate extension for all online quizzes/exams)
________Test Scribe ________Test Reader _________Word Processing
_________Calculator ________Private Room
Other (please specify)_______________________________________________________________________
Accessibility Resources Signature: _____________________________Date:___________________
___ Check Acc. Plan _____Email Online Instructors ___ Staff Signature ___ Enter in Database ___ Original sent to Instructor _____Copy & File in 3-ring binder
_______________________________________________________________________________________________________________________________________
SECTION 3: INSTRUCTOR’S SECTION
This student is eligible to use the above testing accommodations based on a documented disability. Please read the
information below, sign and return this form promptly to Accessibility Resources (ML 132). Any questions regarding the
accommodation should be directed to the Accessibility Resources Director or Assistant Director at 507-389-2825.
1. It is the course instructor’s responsibility to communicate the test accommodations to any teaching assistant or lab
instructor affiliated with this course to ensure accommodations are provided in all testing/assessment environments.
2. Tests are administered M-F between 7:30am-4:30 pm in the Accessibility Resources testing rooms, ML 132.
3. The course instructor will receive an e-mail 3 days prior to the test date from disabilitytesting@mnsu.edu. An Exam
Proctoring Conditions Form will be attached to the email and should be completed and returned with each exam.
4. Test Delivery: Completed exams will be delivered to the department office during the academic year and can be
picked up between the hours of 7:30 AM and 4:00 PM, Monday through Friday during summer session.
5. It is the course instructor’s responsibility to maintain confidentiality with student disability status.
Instructor’s Signature: ___________________________________Date_________________
Please sign and return to Accessibility Resources (Memorial Library 132)
Failure to return a signed agreement does not negate the requirement to provide the test accommodation. (6/20/17 JAS)
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ALTERNATIVE TESTING CONTRACT
Accessibility Resources works with faculty and students to provide an accessible testing
environment for students with disabilities. Accessibility Resources understands the academic
rigors and safety measures that University instructors undertake in preparing and administering
their exams. In an effort to uphold a secure testing environment and manage an efficient
alternative testing system, we have developed the following standards and procedures which we
expect students to adhere to:
• All test materials, including calculators, formula sheets, etc., will be checked prior to the
start of the exam to assure that they conform to the faculty’s directions.
• Once testing begins, restroom use is discouraged. Students who need to use the restroom
will be escorted and monitored.
• Cell phones, smart watches, pagers, student backpacks, hats, bags, audio devices, etc. are
not permitted in the testing room. Cell phones will be collected and left on the testing
envelope at the front desk during testing.
• Students who are more than a half-hour late of the scheduled start time will not be
permitted to take the exam without approval of the faculty member.
• Students may not converse with others in the testing room.
• Students are expected to uphold the integrity of the examination process and are subject
to disciplinary action for academic misconduct if the content of the test is prematurely
shared with others. Second offenses will be reported to Student Affairs Conduct Office.
• A security measure for each testing room includes surveillance cameras.
Accessibility Resources staff will dismiss any student observed utilizing any unauthorized
resource or involved in other inappropriate test behavior at any time during an exam. Any
suspected evidence of inappropriate testing behavior will be documented and reported to the
appropriate faculty.
• A three day notice for scheduling exams is required to facilitate effective
communication with faculty and ensure timely test delivery.
• Tests must be taken on the same day and time the class is testing, unless there is prior
approval by the instructor.
• If I am unable to keep my testing appointment, I must call Accessibility Resources
(389-2825) to cancel. The instructor will decide if I am allowed to reschedule the
test.
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SECTION 1: STUDENT SECTION: Students, please complete all (Minnesota State University, Mankato)

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Completed 23 August 2020

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