Educational Access Services Exam Request Form
Colorado Mesa University
Return forms to EAS Office, Houston Hall 108
Phone 970-248-1856; Fax 970-248-1988
Submit requests at least three (3) school days prior to the exam.
Submit midterm exam requests at least one (1) week prior to the exam.
Submit final exam requests at least two (2) weeks before finals week begins.
Section for STUDENT to Complete:
Name:
700#:
Course Name and Number:
i.e. PSYC 150, ACCT 201
Check if this is a test online and you will need a computer:
Professor’s
Name:
Please check your accommodations:
1½x
2x
Reader
Writer
Other:
Section for INSTRUCTOR to Complete:
DATE and TIME of TEST: Please verify DATE and TIME with Student
Test
How much time is the CLASS
Time:
date:
ALLOWED for the test?
Test Delivery to EAS:
Email to eastesting@coloradomesa.edu
Drop off at EAS office
Other:
Preferred Method of Test Delivery from EAS
EAS Student staff delivers
Professor picks up from EAS
Other:
the test to your department
office
MATERIALS ALLOWED: Please Initial all appropriate areas, including NONE
Open
Open
NONE
Calculator*
Tables/Charts
Other:
Book
Notes
* Clear memory? Yes
No
Signature:
Date:
***EAS Office Use ONLY: ***
Test received by:
Test Type: Essay
Date:
M.C.
Combo
Time:
Foreign Language
Math/Chem
Special Instructions for Monitors:
Test Date:
Actual Time Start:
Monitor:
Test Room:
Student Initials:
Monitor Initials:
Time Delivered:
Completed Test
returned to: (Signature)
Actual Time End:
Semester week #:
Contents in envelope:
EAS Staff Initials:
Date:
Revised 02/01/13