Accessibility Resources (AR)-- Test Request Form

Student's Name Student's Name * First Last
Student's Cell Phone Student's Cell Phone * - ### - ### ####
Student's Email *
Professor's Name Professor's Name * Title First Last Suffix
Class (i.e., ENGL 203) *
Have you talked with your professor about taking the test with AR? *

Have you talked with your professor about taking the test with AR? YES NO

If you haven't talked to your professor about testing in AR, please do so ASAP!
Test Date Test Date * / MM / DD YYYY
Test Time Test Time * : HH MM AM/PM

Tests must be taken at same time class is taking test unless permission is received otherwise!
If you are requesting to take the test at a different day/ time than your class, please explain why. *
I will need to use the following for my test:

I will need to use the following for my test: Computer or Laptop Screen Reader Separate Room