HARTNELL COLLEGE
DSP&S
Building B Room 107
Phone: 831-755-6760 Fax: 831-770-6120
TESTING ACCOMMODATIONS REQUEST
Student:
Date:
Student ID #:
Semester:
It is the STUDENT’S RESPONSIBILITY to return the completed form to DSP&S after meeting with his/her instructor.
This form cannot be submitted by your instructor.
Student & DSP&S Proctor Completes 1 – 3
1)
Instructor’s name
Date of exam:
Course Title (ie: ENG101)
Time:
INSTRUCTOR Completes 4 – 7
4) Please complete and/or initial all areas below:
Length of classroom exam:
Date class takes exam:
Time:
If there is difficulty with scheduling (please initial):
DSP&S may schedule test at a different day/time.
2) DSP&S Proctor initial only items authorized by
Counselor or LD Specialist.
(Verified by DSP&S staff):
)
Extra testing time:
1.5x
2.0x
Reduced distraction environment
Braille test (request 3 days in advance)
Enlarged Test
Reader verbatim
(text-to-speech)
Writer / Typist verbatim
Scantron Assistance
Write directly on test form (not Scantron)
Dictionary / Electronic spelling aid or Thesaurus
Computer adaptations (Kurzweil, Dragon Dictate)
Sign Language interpretation of test instructions
Other (Specify):
3) Student – before you sign:
ƒ Review the DSP&S Test Proctoring Procedures,
Student Conduct & Policies on the back of this form.
ƒ By signing below, you understand and agree with the
DSP&S Test Proctoring Procedures, Student
Conduct & Policies.
Student’s Signature
Test Arrived at DSP&S:
Delivered by:
Date:
Time:
Received by:
Phone Number
ƒ Test must be taken on or before:
DSP&S cannot schedule the test at a different day/time.
Test materials allowed (Please initial each allowed):
Blue Book
Open notes
Scratch paper
Dragon Dictate
Open book (Title:
Calculator:
Regular
Scantron
Dictionary/spell-check
Computer
Kurzweil Reader
)
Scientific
Graphing
Other:
(Specify - ie: Periodic table, 3x5 card with hand written notes, etc.)
5) Exam Delivery to DSP&S (Pick-up service not available.)
Instructor will Email exam to hgentry@hartnell.edu
Instructor will FAX exam to 770-6120 (a secure FAX)
Instructor will hand-deliver exam to DSP&S office
Student will deliver in sealed envelope on/before exam day
6) Exam Return to Instructor
Student will return exam to instructor in sealed envelope.
Instructor will pick up exam from DSP&S office.
DSP&S will place exam in inter-office Mail Box #:
7) Instructor – Before you sign:
Verify that you’ve received this student’s official
DSP&S Confidential Request for Reasonable
Accommodations. Do not sign if you find a discrepancy.
Instructor’s Signature
Test Proctoring Information:
Time started:
Time ended:
Date:
Proctor/ Scribe:
Phone Number
Test Returned to Instructor by DSP&S:
Returned By:
Where:
Date:
Time:
DSP&S Test Proctoring Procedures Student Conduct & Policies

The left side of the “Testing Accommodations Request” form (items 1-3) must be
completed by a DSPS Proctor and the student.

ALL exams and finals must be scheduled 5 days in advance (work days).

Tests must be taken on the same day that the class is scheduled to take the exam. (Only
rare exceptions will be made due to scheduling conflicts.)

Tests must be completed during a single testing session.

Arrive on or before the scheduled test time. If you are late, that time will be counted as
part of your test time - - just as it would for a non-disabled student arriving late for class
on test day. If you miss your scheduled exam time, we will return the exam to your
instructor. It is then up to you to see if the instructor will allow a make-up exam. If your
instructor approves a make-up exam, you will need to complete a new Testing
Accommodations Request form. You may then reschedule a new testing time with us.

Only test materials authorized by the instructor in writing prior to the test will be
allowed (class notes, dictionaries, calculators, textbooks, etc.).

Accommodation tools such as spell checkers, etc. will be allowed only when specifically
approved in writing by your DSP&S Counselor or LD Specialist.

Use the restroom prior to your arrival at the test taking site. If you must use the
restroom during your exam, your instructor may be notified.

Eating, drinking (other than water), smoking or phone calls will not be allowed during
the test. However, special arrangements may be made for final exams that last more
than three (3) hours long.

Cell phones are not allowed in the testing area.

Cheating is forbidden and will be reported to your instructor. Any irregularities during
the testing session (e.g. - use of notes or textbook without instructor’s approval) will be
noted and reported to instructor. Testing accommodations will be suspended for the
student for the semester (in the case of final exams, the following semester). In
addition, the student may face other sanctions as determined by the instructor and as
outlined in the Hartnell College Student Code of Conduct.

No children will be allowed in the testing area.
Test Proctoring Procedures & Policies 10/13