Testing Accommodations Form

PLEASE SCHEDULE YOUR TESTS ASAP OR AT LEAST 4 SCHOOL DAYS IN ADVANCE!
Once you have submitted the form, Mrs. Lindsay will reply within 24 business hours. Your teacher will be informed once we have arranged your testing appointment.

Name Name First Last
Email
Phone Phone - ### - ### ####
Teacher's Name
Teacher's Email
Class/Course
Will you need a computer for testing?

Will you need a computer for testing? Yes No
Which Test #?

Which Test #? 1st 2nd 3rd 4th 5th 6th Mid-term Final
Actual Test Date Actual Test Date / MM / DD YYYY
Actual Test Time Actual Test Time : HH MM AM/PM
Request three dates/times that would work with your schedule. You will be contacted via email or phone to create the appointment.
Date Date / MM / DD YYYY
Time Time : HH MM AM/PM
Date Date / MM / DD YYYY
Time Time : HH MM AM/PM
Date Date / MM / DD YYYY
Time Time : HH MM AM/PM
Accommodations Requested; Check all that apply

Accommodations Requested; Check all that apply Extended Time Distraction-reduced environment Reader Other/specify Other/specify
Checkboxes

Checkboxes I understand that if I DO NOT sign up for testing 4 days in advance that I may not be able to test. I understand that it will be up to me, the student, that if I do not sign up in a timely manner, it is my responsibility to make sure my teacher knows to send my test to the testing administrator rhondalindsay@ladelta.edu (if the date is okayed by her). I understand that I need to give three dates and times, and the dates selected are first come first serve. I understand that the times that I can test are 8:00a.m., 8:30a.m, 9:00 a.m., 9:30 a.m, 10:00a.m, 1:00p.m, 1:30p.m. and 2:00p.m.
Please type your full name below if you understand the following: I understand that I will not be able to take my phone, smart watch, and other unauthorized devices/notes in my testing area, and my phone will be placed on the testing administrator’s desk. I also understand consequence of any violation will be reported to my teacher.

Testing Accommodations Form

Testing Accommodations Form

Request three dates/times that would work with your schedule. You will be contacted via email or phone to create the appointment.