Gallaudet University
The Center of Academic Programs and Student Services (CAPSS)

CAPSS > Office for Students with Disabilities > Forms

Testing Service Request Form

Print a hard copy and submit by mail, fax or in person.

Requestor:

Student Name:
Instructor Name:
Course Name:
Semester:	Fall 2006 Summer 2007	Spring 2007 Fall 2007
Office Address:
Phone:
E-mail:

Test submitted by:

Instructor	Student
Faxed	Other
Faxed

This test is to be taken no later than Day / Date /

If a student IS ALLOWED any of the following items when taking the test, please indicate!

Dictionary	Calculator
Formula Sheet	Notes
Open Book	Scrap Paper
May take breaks	Special Comments

Method of returning the test:

OSWD will deliver to (department name)

Instructor will pick up

Student may return the test to his/her instructor

Thank You.

For more information or assistance, contact:

College of Liberal Arts, Sciences, and Technologies
Center for Academic Programs and Student Services (CAPSS)
Gallaudet University Office for Students With Disabilities
Student Academic Center Room 1220
800 Florida Ave. NE
Washington, D.C.20002-3659
(202) 651-5256 (V/TTY)
oswd@gallaudet.edu

Gallaudet University The Center of Academic Programs and Student Services (CAPSS)

Testing Service Request Form

Requestor:

Test submitted by:

Method of returning the test:

Gallaudet University
The Center of Academic Programs and Student Services (CAPSS)