Specialized Support and Disability Services
Exam Office: 215 Central Academic Building (CAB)
University of Alberta Edmonton AB T6G 2G1
Phone: 780-492-9816; Fax Main Office: 780-248-1665
ssdsexam@ualberta.ca; www.ssds.ualberta.ca
EXAM INSTRUCTIONS & AUTHORIZATION
In accordance with the Policy for Students with Disabilities (passed GFC 1988), SSDS is responsible to assess and recommend
services and reasonable accommodations, based on the documentation of disability(ies), and appropriateness to the
students’ academic work. In the case of exam accommodations, the accommodations are outlined in a “Letter of
Accommodation” the student is asked to present to you at the beginning of the term. Subsequently, we provide students
this form to give to you which must accompany each exam. Instructors are welcome to arrange the exam accommodations
within their departments, according to the recommendations of the SSDS advisor. However, for most situations, instructors
prefer to utilize the exam services of SSDS, in which case we ask that this form be completed in full.
Student’s Name:
Course Name & Number: ______________
first
Date of Exam:
last
Class Start Time: _____________
SSDS Start Time: ____
_________
I need this exam to be converted into an alternate format (e.g., audio-tape, Braille, e-text, enlarged) □ Yes □ No
SSDS exams may be scheduled to begin earlier than the regular class start time but will overlap the class start time by at least 30 minutes,
thereby maintaining the security of the exam as outlined in the University of Alberta Calendar Conduct of Exams 23.5.1 (4). In the event
that students finish exams before the 30 minute overlap has expired, they would be obligated to remain at SSDS, under supervision, until
30 minutes after the in-class exam has begun. During that period, students will not have access to computers, phones or other electronic
or communication devices.
 The above information is to be completed by the student.
 The above information should be reviewed by the instructor; please edit if there is an error.
 The remaining information on this form is to be completed by the instructor.
 The completed form should be delivered with the exam to the SSDS Exam Office 215 CAB.
EXAM DETAILS: Indicate below which type of exam, the time allotted, and answer questions 1 – 3 on page two.
 □ Fall / □ Winter Midterm Exam or
 □ Fall / □ Winter Final Exam or
 □ Quiz/ □ Test (any semester) or
 □ Midterm exam for full year course
 □ Spring / □ Summer Final Exam
At SSDS, these exams are normally written at the
same time as the students in the classroom.
Exams should be received at least one work-day in
advance. * If exam is to be converted to an Alternate
Format, as indicated above by the Student, then
please e-mail the exam two work-days in advance to
ssdexam@ualberta.ca
Time allotted for in-class exam:
□ 50 minutes
□ 80 minutes
□ 2 hours
□ 3 hours
□ Other __________
SSDS final exam start times are as following :
9 am exams begin at SSDS at 8:30 am
2 pm exams 3-hours in length begin at SSDS at 11:30 am
2 pm exams 2-hours in length begin at SSDS at 1:00 pm
Exams should be received at least one work-day in
advance. *If exam is to be converted to an Alternate
Format, as indicated above by the Student, then please
e-mail the exam two work-days in advance to
ssdsexam@ualberta.ca
Time allotted for in-class exam:
□ 1.5 hours
□ 2 hours
□ 2.5 hours
□ 3 hours
□ Other __________
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Enclosed are exam booklets  □ Yes □ No or scantron sheets,  □ Yes  □ No as required for
this exam.
1. Is there a hardware or software component required for the exam?
 □ Yes
If yes, choose format: □ Cassette □ CD □ DVD □ Digital file □ Internet □ Other:
2. Permitted items: (please choose which apply)
a) Data or formula sheets (prepared by student)
b) Open book exam (all items allowed)
c) Notes only
□ Yes
□ No
d) Textbook only
□ Yes
□ No
e) Calculator
□ Yes
□ No
 □ No
Comments or instructions (if any):
□ Yes □ No
□ Yes □ No
□ Programmable
□ Non-programmable
□ Any
f) Other, please specify:
3. Will you be available by phone, during or after the exam, in case the student has questions? □ Yes □ No
Contact # or info:
. Please feel free to come to Exam Office to check on student.
EXAM DELIVERY Please check which method will be used:
Note, an Exam and Instructions & Authorization form must accompany every exam. It can be accessed
on our web site at http://www.ssds.ualberta.ca/DocumentsandForms.aspx
OR it can be requested from and returned to ssdsexam@ualberta.ca.
Please note: if the exam is to be converted to an Alternate Format, as indicated on page one by the
Student, then please e-mail the exam two work-days in advance to ssdsexam@ualberta.ca
 Student picks up from instructor one work-day in advance and brings to SSDS in sealed & signed envelope.
 Instructor or designate delivers exam to SSDS Exam Office, 215 CAB, at least one work-day in advance.
 E-mail at least two work-days in advance (in case of network problems); in the subject line indicate
course name & number, student name and exam date (e.g., ENGL 111 exam Feb 15, Tom Brown). Be sure to
attach this Exam Instructions and Authorization form. Send to ssdsexam@ualberta.ca. You will receive a
reply acknowledging receipt – if not, it may not have been received – please contact our staff.
 FAX to the SSDS Main Office at 780-248-1665 (including both sides of this authorization form) at least
one work-day in advance; indicating: course name & number, student name and date of exam on the
cover page.
COMPLETED EXAM RETURN Please choose one method:
 Student Return: Student returns the exam in a sealed envelope that has been stamped with the SSDS
stamp and signed by one of our proctors, to the address listed below.
 Instructor Pick-up: The instructor or a designate picks up the exam from the SSDS Exam Office.
Instructor’s Name:
Office Phone:
Please Print
Department:
Dept. Phone:
Address:
Instructor’s Signature:
Date:
If you have any questions, feel free to contact an SSDS Exam Administrator at 780-492-9816.
Personal information on this form is collected under the authority of Section 33. (c) Of the Alberta Freedom of Information and Protection of Privacy Act for
the purpose of administering exam accommodations at SSDS. Personal information on this form may be shared with University of Alberta faculties,
departments or units. I hereby give permission for the information I have provided to be used for the above noted purposes. Questions regarding the
collection, use or disposal of this information can be directed to Specialized Support & Disability Services, 2-800 Students ’ Union Building (SUB), phone
780-492-3381, TTY 780-492-7269 or e-mail: ssdsrec@ualberta.ca.
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