Academic Services Center

DSS Exam Reservation Test Form

Library 215
Hours 8 - 12 p.m. and 1 - 4:00 p.m.

Please complete this form and return it with the test or quiz at least 2 business days prior to test date to Disability Services, Library 215.

Date:
(mm/dd/yyyy)
Test for:

Instructor Name:

Instructor Phone:

Course Name and Number:

Date and time test must be competed:

Time allowed for rest of class to test:

Accommodations Approved by DSS
Audio	Scribe	Interpreter	Private Room	Extended Time	Quiet Room

Test Instructions
Check whic one applies to this exam.
May use book:

May use a calculator?

May use dictionary?

May use notes/formulas:

Computer access?

Select method of return:

Special Instructions or Notes


Contact information:
E-mail - Joy.Eichhorn@ndscs.edu
Phone: 671-2623