Fillable TestAuthorizationForm 17 TestAuthorizationForm 17

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TestAuthorizationForm 17 TestAuthorizationForm 17

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________________________
TEST AUTHORIZATION FORM
Student’s Name:
Course Name:
INSTRUCTOR TO COMPLETE THE FOLLOWING:
Amount of time given to class for:
TEST: QUIZ:
Materials Allowed (mark with an “X” in the box)
No Materials (pen or pencil only)
Scratch Paper (returned with exam)
Dictionary
Rest Room Breaks
Notes
Other
Special Instructions for Test/Quiz:
PLEASE ANSWER: (mark with an “X” below in one box or the other)
Will these parameters remain the same for all Tests/Quizzes this semester?
Ye s
No
(If “YES” then this Test Authorization form will apply to all DS Students in this class - no other form needed)
Do you require DS Students to take Test/Quizzes on the same day as the class?
Ye s
No
(If “NO” what is the last day that the Student can take this Test/Quiz?)
MISSED EXAM POLICY:
If a student misses a scheduled Test/Quiz we will keep the Test/Quiz until 3pm the next business day, at which time
the Test/Quiz will be shredded.
TEST RETURN INSTRUCTIONS: (Put “X” below in one box or the other)
Will pick up from Disability Services
(number to call for pick up)
Deliver this test to instructors Dept.
Bldg:
Dept Office Room #
Instructors Signature:
Date:
Campus Phone ____________
_ Off Campus Email
_____________________________
NOTICE TO INSTRUCTOR:
1. A Test Authorization Form must accompany each test/quiz if your parameters change from test to test.
2. Instructors can send/deliver a test/quiz to Disability Services an hour prior to the student’s scheduled test/quiz. Hand Delivery
(Grace Wilkie Hall Rm 203), Email (ds.testing@wichita.edu), Fax (978-3114), or by Digital Drop Box.
3. Instructors are responsible for providing: Scantron answer sheets or any other materials that accompany the exam not listed above
as items the student would provide.
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TestAuthorizationForm 17 TestAuthorizationForm 17

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Completed 11 March 2020

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