Request for Exam Administration

Students must submit exam administration requests one week before the exam. This provides the Coordinator of Student Accessibility Services with adequate time to coordinate with the appropriate instructor.

Every effort is made to accommodate late requests. However, with less than one week's notice, there may not be enough time for the instructor to provide the Coordinator with the exam. As such, the accommodation of requests submitted with less than one week's notice cannot be guaranteed.

If you are using a mobile phone to complete this form, please contact Student Accessibility Services to confirm, the information may not submit properly (even if you do not see an error).

If you have any questions or concerns, please contact:

Jeffrey S. Ogden
Coordinator of Student Accessibility Services
Phone: (603) 899-4126
Office: Center for Academic Excellence (Library, 1st floor)

Please note: This form is to be used for exams during the semester only. A slightly different form and procedure will be used for final exams. Students with test-taking accommodations will be notified of this procedure as final exams approach at the end of the semester.

*Last Name:
*First Name:
*Instructor Name:
*Date of Exam:
*Time of Exam:
*Requested Accommodations:
Please do not request an accomodation that is not listed on your "blue sheet".
Extended Time Reduced Distraction Setting
Use of Computer Use of Calculator
Reader Scribe
*Will extended time on this exam create a schedule conflict?
Example: You have 90 minutes to take an exam beginning at 8:00, but have another class at 9:15. If you select "Yes," you must contact the Coordinator of Student Accessibility Services to inquire about alternative arrangements.
Yes No
Permitted Materials
If your instructor has indicated to the class that students may use one or more of the following materials during the exam, please check the appropriate box. Permitted materials will be verified with the instructor.
Open Notes Open Text
Personal Computer Permitted "Cheat Sheet"
Calculator Other: 
Notes,Comments, and/or Questions