Picture: Header for Nipissing University Disability Services
Testing Accommodation Request

 

WARNING!!!--Remember, your request is NOT complete until you have received confirmation from Disability Services. If you do not receive confirmation within 2 school days (Monday-Friday), your request has NOT been received and you will not receive accommodation. Contact Disability Services at 474-3450 ext. 4331--
 

I have self identified to this professor: YES: / NO:

Name:
Student Number:

Course (ie.HIST3213):
Date of Test:

This is a...
Test/quiz
Mid-term
Final exam

Class Start Time:
Class End Time:

Test Start Time:
Test End Time:

Classroom:
Professor:

Format of Test:

Essay
Multiple Choice
Short Answer
Lab Test
Other

Requested Accommodations:

Distraction Reduced Environment
Additional Time (1/3 extra)
Additional Time (1/2 extra)
Computer
Kurzweil
Dragon Naturally Speaking
TextHelp
Spell Checker
Exam Enlarged
Pain Break
Washroom Access
Allergy Free Room
Adjustable Chair
Foot Stool
Obus Forme
Other:

NOTE: All accommodation requests must be made at least 7 days before the date of the test. If this request is less than 7 days please explain why:

Your Nipissing email address:

Protection of privacy

The information on this form is collected under the authority of the Nipissing University Act, 1992.  It is related directly to and needed by the University to provide services and to support disability-related accommodation requests for students with disabilities.  The information will be used by employees of the Counselling and Disability Services Office and will not be disclosed to any third party without your written consent.  If you have any questions about the collection, use, and disclosure of this information please contact the Counselling and Disability Services Office, Nipissing University, 100 College Drive, North Bay, ON P1B 8L7, (705) 474-3450 ext. 4493.
Disability Services Quick Links