| Today's Date: |
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| Name: |
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| Telephone: |
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| Course: |
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| Professor: |
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| Class Test Day and Date: |
Class Test Time: |
| If you are requesting to take the test on a different day or time, please indicate below: |
| Day/Date: |
Time: |
| Delivery Arrangements: |
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Academic Adjustments Needed:
(check all that apply) |
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| Test Parameters: |
| Expected average length of time class will be testing: |
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| Conditions set by professor:* |
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| *If any of these three conditions are checked, OSS will verbally confirm them with your professor. |
Before you submit this request, please print a copy for yourself
and one copy for your professor.
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