Accommodative Testing Appointment Form

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Accommodative Testing Appointment Form

This online form is for students who want to make an appointment to take a test or quiz with accommodations such as extended time, computerized reader, etc. If you submit this form 3 business days or less prior to your desired appointment date, please contact your instructor directly to make sure that s/he will be able to send a copy of your exam.

First Name

Last Name

Phone Number

e.g. (999) 999-9999

OCC ID

e.g. 9999999999

Course Name (The Subject the test is in):

Course Instructor

Course Instructor Email

Date of Test

Time of Test

Location of Test:

Testing Services Office, Coulter Library room 103

OCC@Liverpool main office (Do not select this option if you are not registered for classes at OCC@Liverpool)

Accommodations Needed: (enter none if no accommodations are needed)

Preferred means to contact you

Phone

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