Clayton State University
Disability Resource Center

Alternative Testing Form (Online)

Please complete this form in its entirety.

Name of Student
Course and Section #
Instructor
Instructor's Campus Ext.
Instructor's Office Address
Scheduled Test Date
Time
Normal allotted time for test
 
Please check appropriate instructions:
Item Allow Do Not Allow
Calculator
Computer Internet Connection? Yes No
Dictionary
Notes
Text/Books/Articles
 
How should the test be returned?
Delivery by campus Mail
Instructor will pick up
Student will hand carry in a sealed envelope
Disability Resource Center to hand deliver to:
Location of Classroom
Location of Office
 
Student began test: Date Time and ended test at Time
Administered by:
Testing Irregularities: