First Name

Last Name

Email

Are you registered with SAS?YesNo

Cell Phone

Major

Course

Course Code (and Section)

Do you use a screen or text reader to view notes?YesNo

Course Instructor

Date of Exam

Time of Class

Amount of time allotted for the exam

Other classes or exam conflictsYesNo

Conflict TypeI have a class immediately before this examI have a class immediately after this examI have a lecture for this class immediately before or after this exam

If you are requesting an exam time, that is different from the scheduled time of the class, please briefly explain why:

Approved accommodationsExtended time (25%, 50%, 100%, 150%)Use of screen reader (RWG, Jaws, Dragon)Use of laptop for typing (no internet allowed)Use of laptop for online examUse of a basic calculatorSoftware needed (SPSS, MatLab, LabViewOther

Online CourseYesNo