EXAMINATION REQUEST FORM
DISABILITY RELATED
Center for Access and Academic Testing
Math Rm. 201; Box T-0940; Phone: 968-9423;
E-mail: caat@tarleton.edu ; URL: www.tarleton.edu/caat
IT IS THE STUDENT’S RESPONSIBILITY TO RETURN THIS COMPLETED FORM
For Student Use Only
Name:
ID#:
Cell Phone: (
)
Email:
Course Name & #:
Testing Date:
Requested Time:


Please print legibly and fill out this section COMPLETELY.
Testing appointments are available M-F from 8-12 and 1-5. An exam will ONLY be given from 12-1 if the
instructor requires that hour.
 Take the form to the instructor to have him/her complete the remaining section with a signature.
 Student should return the completed and signed form to Center for Access and Academic Testing (CAAT) at
least one week prior to exam date. If the office is closed, please slide form underneath the front door.
 Students are responsible for bringing all approved items with them to the exam unless provided by instructor.
CAAT does not provide calculators or scantrons.
 This office has the right to deny a request if these procedures are not followed or if this form is not turned in within
a reasonable time to provide the accommodations needed.
 If a student is more than 15 minutes late (according to CAAT time) the exam will not be administered until
permission is obtained from the instructor.
 The following items are prohibited in testing rooms: cell phones, candy, food, drinks (including water), or any
other items without permission given by CAAT staff or instructor.
For Instructor Use Only


Please review form for accuracy.
Complete the area “Class Day” and “Class Time” (this is the amount of time the general class is allowed; the
Center for Access and Academic Testing will calculate any extended time).
 If the regular time of the exam will not fit within academic testing hours of operation, or if it does not allow the
student to utilize his/her extended time due to back-to-back classes, an alternative exam date and/or time must
be chosen. Once agreed upon between you and the student, place your initials next to the alternative date and
time.
 You must sign this form; if not signed by the instructor it will not be valid or approved and the student will not be
allowed to test with CAAT.
If additional resources are needed, please initial the blank!! Must be initials of instructor to be valid. If
the instructor’s initials are missing the student will not be permitted to use the resource.
_________ Non-programmable Calculator
_________ Graphing Calculator
________ Scratch Paper
________ Tables/Formulas
_________ Note Card
_________ Notes
________ Textbook
________ Other (specify):
Exam to be delivered by:
 Email: caat@tarleton.edu
 Hand deliver by instructor (Math 201)
Return exam by:
 Pick up by instructor/staff member
 E-Mail
Class Day__________________ Class Time_________ -- ___________
Do you require the student show CAAT their
ID before taking the exam?
 Yes
 No
Instructor name:_______________________________________Signature_________________________________
Email:
Phone #:
T-Box:
For Center for Access and Academic Testing Use Only
Calendar Date:
Time:
Initials:
Test Time allowed: Hr(s)______ Min(s)_______
Approved exam accommodations for student:
 Extended Time (unless time is being tested)
 Non-Distractive Environment
 Braille
 Reader
 Use of a computer for typing only





Use of speak and type software
Calculator
Scribe
Use of a spell check device
Other __________________________
Request Test from Instructor
First Attempt: Date:
Time:
Email_______ Phone Msg._______
Second Attempt: Date:
Time:
Email_______ Phone Msg._______
Test Received Date:
Time:
Test Taken Start:
Email_______ Hand_________
Stop:
Notified instructor: Email_______ Ph. Msg._______
Picked up by: ________________________________Date:____/____/______
Comments:
Class Time
MWF
8:00-8:50
9:00-9:50
10:00-10:50
11:00-11:50
12:00-12:50
1:00-1:50
2:00-2:50
3:00-3:50
T/TR
8:00-9:15
9:25-10:40
10:50-12:05
1:00-2:15
2:25-3:40
Time & 1/2
Stop Time
25
25
25
25
25
25
25
25
9:15
10:15
11:15
12:15
1:15
2:15
3:15
4:15
40
40
40
40
40
9:55
11:20
12:45
2:55
4:20
Regular Class Time Allotted
50 minutes
1 hour 15 minutes
1 hour 30 minutes
2 hours
Time & ½
1 hour 15 minutes
1 hour 55 minutes
2 hours 10 minutes
3 hours
100% Time
1 hour 40 minutes
2 hours 30 minutes
3 hours
4 hours
Final Exam Class Time Allotted
2 hours 30 minutes
Time & ½
3 hours 45 minutes
100% Time
5 hours