Please meet with your instructor prior to completing this form to discuss test delivery and additional materials allowed.
Student first name (required)
Student last name (required)
UO ID (required)
Student phone (required)
Student emaill (required)
Course subject code & number (required) (e.g., PSY 201)
Exam day and time (required) (time you will take the exam)
Exam date (required) (date format: month/day/year - 01/01/2008)
50% Extended time
Reader
Scribe
Computer
Reduced distraction test location
Other Please describe
Student delivery
Instructor email attachment to disabsrv@uoregon.edu
Instructor drop off
Student return
Instructor pick up
Additional materials allowed
Instructor email for confirmation (required)