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Testfile (Columbia College)

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File type: PDF

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Test Accommodation Request
Disabled Students Program and Services
Columbia College
209-588-5130
This request for proctoring is made in accordance with federal and state laws and regulations which govern support services to students with
disabilities. Please complete and return this from in order to have your test proctored in accordance with your wishes.
Student Name
Instructor Name
Course Title
Date
Date of Exam
Exam Begins
Exam Ends
By Arrangement
Part 1: To be completed by Disabled Students Program and Services (DSPS)
Time and a half Double Time
Word processor with dictionary
Word processor without dictionary
With spell check
With large print
Test completed on computer
Student may dictate test into recorder
Test read aloud to student
Proctor records answers
Test print enlarged
Test is recorded on tape
Other
Staff Signature
Ext: 5130
Part 2: To be completed by Instructor. Please Initial: (do not use checkmarks)
Open Book
Notes Permitted
Formulas Permitted
Calculator Permitted
Speller Permitted
Dictionary Permitted
Scantron Permitted
Green Book Required
Student may work independently Proctor should stay with student entire time
Other
Test Delivery
I will deliver exam to mailbox of DSPS
I will deliver exam to DSPS Office Exam returned to my mailbox by proctor
I will pick up exam from DSPS Office
Test Return
Exam returned to me by student in sealed envelope
Additional Instructions:
Instructor Signature Department Extension
I will E-mail Exam to DSPS
Exam returned to me by E-mail
Select Record
Extended Time:
Submit to Instructor
Submit Back to DSPS
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Testfile (Columbia College)

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Completed 18 July 2020

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