Test Accommodation Request

If you are a current student with disability at Union College and you have been approved to receive testing accommodations through the TLC, you may use this online form to make your test accommodation requests. The TLC office coordinator will review your request, e-mail you a confirmation, and forward your request on to your instructor.

Remember: All accommodation requests should be made three to five business days before the exam.

For more information, consult the TLC Test Request Procedure (PDF) or call our office at 402.486.2506.

Student Information

Name: *

E-mail Address: *

Test Information

Course Name: *

Instructor: *

Type of Test: *

Quiz

Test

Final Exam

Date of Test: *

MonthJanFebMarAprMayJunJulAugSepOctNovDec

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Year201120122013201420152016

Time of Test: *

hour123456789101112

:

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am

pm

Accommodations:

Time and a half

Reader

Scribe

Quiet room

Computer

Other (please specify below)

Adjusted Start Time:

hour123456789101112

:

minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859

am

pm

If you need to start your test at a different time than what is scheduled in class in order to receive time and a half, indicate what time you are requesting to start your exam here, then explain in the comments section below.

Where are you requesting to take the test?: *

At the Teaching Learning Center

In the classroom

In a quiet room provided by the instructor (if available)

What is the format of the test?: *

On paper

On a computer (provided by the TLC)

On a computer (provided by myself)

What will you be using to take the test?

Comments:

Enter any additional information that my be pertinent.