On line Test Accommodation Request Form

ON-LINE Test Accommodation Request Form

Student Form Instructions: Please provide all information requested on this form and submit. An e-mail will be sent to the professor for verification and Disability Support Services staff will be notified of the request Test Center Hours- 9:30-17:30-Mon-Thur 9:30-13:30-Fri Time table: 9:00->9:00am 10:00->10:00am 11:00->11:00am 12:00->12:00pm 13:00->1:00pm 14:00->2:00pm 15:00->3:00pm 16:00->4:00pm 17:00->5:00pm If you have any questions, please contact Jtrageser@towson.edu Request must be submitted 7 days in advance DSS is currently accepting requests for tests on or after the following date: 8/27/2008	Student/Course Information:	Professor/Test Information
	Name*	Name*
	E-mail*	E-mail*
	Phone*	Phone*
	Course Title	Test Date*
	Department*	Test Date*
	Course Number	Start Time*	:
	Section	Accommodations	extended time
			reader
			scribe
			computer
			adaptive technology
			Minimal Distraction Space
		Note to Professor: (optional)

		By checking this box I confirm that I have met with and provided the faculty member with written notification of my eligibility for Disability Support Services

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