Phone Number (Best number to reach you):
Please provide your class information - Course Name/Number:
Class Meets On:
Instructor's First and Last Name:
On which campus will you be taking this exam?
Will you need a computer for this exam?
Do you have disability documentation on file with the Columbus State University Office
of Center for Accommodation and Access?
Have you already provided your instructor with a copy of your Letter of Accommodations for this semester?
When is the class scheduled to take the test?
If you have to take it at a time that is different from when the rest of the class will take
the test, you must have the professor's permission. Please explain below if that is the case.
What accommodations do you request for this specific test (choose any that apply).
PLEASE NOTE: you are only able to receive testing accommodations that you have
already been approved for and that were listed on your "Accommodation Letter" to
Quiet Space/Separate Room
If Other, please explain: