Student Accessibility & Accommodation
PHONE: 253.879.3393
EMAIL: saa@pugetsound.edu
EXAM COVERSHEET
If exams or classes are different, please use a separate coversheet.
Section:
Class Exam Time:
Section:
Class Exam Time:
Exam length (w/o accommodation):
Exam length (w/o accommodation):
Student(s):
Faculty Member:
Dept. & Class Number:
Exam Date:
1.
1.
2.
2.
3.
3.
4.
4.
Special Instructions – Please indicate the following:
Open notes
Tables/charts included
Flash drive/memory stick included
Open book
Moodle access
Calculator – scientific
OPEN internet access
Access to a specific website (please indicate the URL):
Other (please specify):
____________________________________________________________________________
____________________________________________________________________________
How can the test proctor contact you if the student has a question?
Phone:
Email:
Other:
Return Method (please choose ONE item below v NOTE: Test will be sent campus mail if not otherwise indicated):
Faculty pick-up
Student walk-back
Campus Mail
Faculty/staff pick-up at SAA
Reception Desk Howarth 105
SAA hours: 8AM-5PM
Student can carry exam back to
faculty member.
Mail the exam to
Initial upon pick-up: ________
Class location:
Office location:
Campus Mailbox Number
(CMB):
SAA Office Use Only: Eligible Accom.: 50% _____ 100% _____ Essay on Comp. _____ Basic Calc. _____