Proctoring Request: Student


Directions:

For each test date, please fill in the below information completely and click submit. You will be contacted by Disability Support Services (DSS) to confirm your test day and time.


Attention New Students:

Before using this form to request exam accommodations, you must register with DSS. If you are not registered, please contact us immediately and begin the process. You will need to supply documentation of having a disability and complete an intake interview. For information on registering, please see:


Disability Support Services

Coordinator Phone: (850) 729-6079

Accommodation Specialist Phone: (850) 729-6014

E-Mail: dss@nwfsc.edu

Student Information
* = REQUIRED
*Exam Date Requested:    example: 01/01/2000
*Beginning Time Requested:

*Student Name:
*Student E-Mail:
*Student Phone:    example: 000-000-0000

*Class Name / Number:
Class Day / Time:
Professor:

Type of Exam
How much time does class normally receive ?

Distraction Reduced

Accommodations Requested For This Exam
Extra Time Percentage
Reader
Scribe
Breaks
Drinks

Additional
Adaptive Technology Alternative Format Text
Please Describe below:

For Accommodations Please Allow the Following Time:

A minimum of 3 business days prior to Quiz and Exam Dates

A minimum of 5 business days prior to Final Exam Dates

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