Center for Learning and Teaching
Office of Special Services - Test Request Form
Please submit Test Request form 24 Hours in advance.
Print Version
Name of Student:
Phone:
Professor's Name:
E-mail:
Course Name/#:
Test Date:
Test Time:
8
9
10
11
12
1
2
3
4
5
6
7
:
AM
PM
Due to time extensions, scheduling issues, and limited seating; the CLT must be informed of the latest date that the test may be taken.
Test will be submitted by:
Email to clt@Roanoke.edu
Test will be dropped off to the CLT
Time Allowed (If Known):
1.5 (time and a half)
2.0 (double)
Student may use:
Calculator:
Notes:
Dictionary:
Computer/Software:
Scratch Paper:
Textbook:
Other:
Student may record answers on:
Test Copy
Ruled Paper
Scantron
Blue Book
Printout
Computer
Other:
Special Instructions
:
(Please list any additional testing instructions)
Delivery of completed test:
(Completed tests held over three days are delivered to the Professor’s office)
Pick-up:
Deliver:
Office Bldg/Room #:
Attach test:
