Stephen F. Austin State University

Testing and Special Classroom Accommodations Request Form

Disability Services

Student Information Student's Name:

Student's E-mail Address:

Course/Event Information Instructor's Name or Event

Course/section

Date

Start time

End time

Location

Event: ie: Testing, Lab, Student Activity

Service Requested

Service Provider

Reader Scribe
Reader Only
Scribe Only
Exam In Room Proctor
Lab Assistant
Other
Special Skills needed (Please describe specific skills needed ie: advanced terminology in Nursing or upper level foreign language)

Assistive Technology

CCTV
WebCT
JAWS
Zoomtext
Alpha Smart Keyboard
Other Computer Software
Other

Other Information Other Instructions

Please coordinate with your instructor any testing accommodations that you need.

Note: Disability Services should receive the exam 24 hours prior to the exam time.

NOTE: Please print form output after submission for record keeping and verification.

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