TESTING ACCOMMODATION REQUEST FORM
STUDENT MUST RETURN COMPLETED FORM TO DSPS (Campus Center 240)
AT LEAST 3 SCHOOL DAYS (72 HOURS) PRIOR TO THE EXAM.
Name
I.D. #
Instructor
Course Title (e.g. ENGLISH 1A)
Date of Exam (IN DSPS)
TIME I WILL START TEST IN DSPS
TEST PARAMETERS (check only those applicable)
Extra Testing Time
1.5 x standard 2 x standard
Enlarged Print Basic Calculator
Computer
Scan-and-read Software
Distraction-reduced room
Title of text
Open Book
Open Notes Dictionary
Calculator?
Basic
Graphing
Blue Book
Scantron
Type/ amount
TEST DELIVERY AND RETURN OPTIONS
DELIVERY OPTIONS
Student will deliver (sealed envelope)
Instructor will deliver to DSPS (CC-240)
Instructor will Email to dsps@wvm.edu
RETURN OPTIONS
Instructor will pick up from DSPS (CC-240)
Student will return (sealed envelope)
Other (Specify)
* NOTE: Your signature indicates that you have reviewed, understand and agree
to the DSPS test-taking policies printed on the reverse side of this form.
Student Signature
Instructor Signature
Email (if not wvm.edu)
Phone (preferred)
STUDENT (COMPLETE AND PROVIDE TO INSTRUCTOR)
Email Address
Check All Approved Accommodations
INSTRUCTOR (COMPLETE AND RETURN TO STUDENT)
Date of Exam ( IN CLASS )
Start Time ( IN CLASS )
Time Allowed ( IN CLASS )
* NOTE: Evening and Saturday tests may be scheduled on a different day and/or time because of DSPS Hours.
Thesaurus
Scientific
* Review the Academic Support & Accommodations form with the student to verify accommodations for the current semester.
Other (specify)
Phone Number
( EXAMPLE: MONDAY BEFORE DSPS CLOSING TIME FOR A THURSDAY TEST)
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Print Form
How to Request Accommodations for Testing:
If a student has met with a DSPS Advisor and received approval for Testing Accommodations for the current
academic term, the student can request testing accommodations by submitting a completed Testing Accommodations
Request (TAR) form to DSPS at least three (3) school days before the exam is scheduled. Please DO NOT call in
your testing request. One form may be completed for each exam the student plans to take. Multiple test dates may be
scheduled on one form
if the test dates are known in advance and if the test directions will be the same for all tests.
Each final exam should be scheduled on separate form. The student will complete top portion (Student) of the form
and sign it, and then give this form to the instructor, who will complete the bottom portion (Instructor) of the form and
sign it. The student must then return the form to DSPS.
The Student's Responsibility:
§ Schedule classes to allow for extra time to complete course exams, if that is a recommended accommodation.
§ Once Testing Accommodations have been approved for the current semester. It is your responsibility to
confirm this accommodation with your instructor(s).
§ Remind the instructor to make a copy of the exam available to DSPS.
§ Schedule exams on the dates indicated in the syllabus and at the time the class normally meets,
except for evening and Saturday classes. If the student wishes to take an exam at an alternate day or time,
the instructor and DSPS must first approve this before the exam is administered. (DSPS may reschedule an
exam if the exam was not received from the instructor or if there is inadequate testing space or staff support at
the originally scheduled time.)
§ Provide all appropriate supplies, such as Blue Books, Scantron forms, paper, and writing implements.
When It's Test Time:
§ If the student is late for the exam, the time missed will be deducted from the time allocated.
§ If you are (1) hour late to an exam, the exam will be returned to the instructor and may not be rescheduled in
DSPS.
§ Begin the exam on time. Reporting 20 minutes or more late for a test, more than twice a semester, may
result in adjustment to accommodations.
§ Books, backpacks, purses, notebooks, fanny packs, cell phones and other personal belongings will be placed
in a locker before returning to the testing site. This applies to everyone. An exception will be made if the exam
is pre-designated “Open Book” or “Open Notes” by the instructor.
Academic Dishonesty:
PLEASE NOTE that testing rooms are monitored by video camera (with audio) and testing room activity may
be subject to videotaping. If evidence of cheating is observed, the test will be stopped, all materials will be
confiscated, the instructor will be notified, and the matter will be turned over to the instructor for further
action. The student will have his/her testing services suspended and will not be reinstated until a
conference between the student, DSPS Director, and, in some cases, the instructor is held.
Examples of cheating include:
§ Copying from another student's test.
§ Allowing another student to copy from your test.
§ Using the textbook, course handouts, notes, or electronic information during a test without instructor
permission
§ Stealing, buying, or obtaining all or part of a test before it is administered
§ Selling or giving away all or part of a test before it is administered
§ Failing to follow test-taking procedures, including talking during the test, ignoring starting and stopping times,
failing to notify DSPS staff when leaving the testing area, or other disruptive activity
DSPS Testing Hours for scheduled tests
Monday through Thursday: 8:30 a.m. - 6:00 p.m.
Friday: 10:00 - 2:00
Saturday and Sunday: Closed
Hours subject to change especially during Summer and Winter Sessions
*If scheduling difficulties,
please see DSPS staff.