Testing Accommondation Request Form

Testing Accommodation Request Form

To ensure your accommodations, send your request one week prior to test date. With shorter notification, we will attempt to meet your testing needs.

You can expect contact from us within 1-2 business days. If you have questions or comments, call us at 281-283-2626.

Student Information
** indicates a required field

** First name

** Last name

** UHCL email

Alternate email

Phone number

  How do you prefer to be contacted?
Phone      Best time
   Email

Testing Information

Course number (example, MATH 3031)

Course title

  Testing date and times must be during normal business hours.
  ** Test date

** Test start and end time

Instructor name

Instructor email

Instructor phone(s)

Testing Accommodations

Please check all that apply.

   Extended time
   Computer access
   Reader/scribe

Other accommodations or comments

When you submit your form, your data is sent securely.
When your form is submitted successfully, you will see a Thank You page.

If you do not get a Thank You, your application was not sent.
If you are unable to send your application, please contact Disability Services at 281-283-2626.

State Law Notice
State law requires that you be informed of the following:

with few exceptions, you are entitled on request to be informed about the information the University collects about you by use of this form
under sections 552.021 and 552.023 of the Government Code, you are entitled to receive and review the information
under section 559.004 of the Government Code, you are entitled to have the University correct information about you that is incorrect.

Date Updated: 18-DEC-2007