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ATR Spring 2012 - Accomlfibqateot Tes Request AT)orm...

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Unformatted text preview: Accomlfibqateot Tes. Request AT )orm Disabitity Resource Center (DRC) Accommodated Testing Service (ATS) University of Florida . 001 Reid Hall (Building 0020) PO. Box 114085 - Gainesville. FL 32611 352-392-8565 ext. 202 (voice) 352-392-8570 (fax) - email: [email protected] - av n mm .5 .. $TlUIDENTTSEQTI.Qn f ' I ' ' . i'iJlaemexip'er: All $é.’<:.tfifcins..nllllsiif.B'e.l¢<i2.lhl2l’ete.cl..- Please review, complete student section, and have instructor complete remaining sections. Submit completed ATR form to DRC not less than {our (4) business days prior to exam date. Confirm (on-line. phone. or email) exam location, date. time. & accommodations not less than three (3) business days prior to each exam date. Requests to modify a scheduled exam (date or time) must be submitted to DRC not less than three (3) business days prior to exam date. All requests to modify schedule must be approved by the Instructor and DRC. Date Received DRC Staff Receiving Form DRC Office Use Only: .n... Student's Signature I Today’s Date Student’s Name PLEASE PRINT _ _ @ufl.edu Student's UFiDll Student's Phone Number Student's UF Email Address - 7 -- 7.|NSTR.U.QTQR SECTION. 3 f . 1. i f f .- . '"Please.Prairidefall. Real-sister! .IPfPTllla-liqll -.-_2 .3.“ Please review. complete Instructor section. and Course & Exam Information. Provide exam materials to DRC no later than 3:80 PM the business day before scheduled exam date. Please note, exams not received by deadline may result in cancellation of the accommodated exam. Exam materials may be sent via email ([email protected]). faxed. or hand delivered to DRC. Exams wilt be available for pick-up upon completion, or will be delivered no later than the next business day alter exam date. Provide complete delivery information. A signature will be required upon return of all exams. _ "- Arab“ C... QKAW in‘m tnstr ctor’sSmlgnatu ‘ instructor's Name PLEASE PRINT \\ _' gaewol 5"“3 instructor's Phone Number (Backup) ..-... instructor's Phone Number (Primary) __lfi'éiégtéib "rxilttéidfsirrrqm‘ Instructors-Glace (Primary Location for Exam Return) I Room Number Building Department Instructor Must Approve Test Aids Room Number . Burldl'ng . . Department COURSE 8: EXAM INFORMATION ' ourselnformatlon PM “sees, we tags, Course Number Course Section Number Exam Emlrmu .. .. - Exam Exam Exam (Please Check All ThatApply) Date Start Time Length Location _r. Permitted Class Exam Tes -lds I‘V'aper I Open Notes I Basic Calculator IJOther: ._, C}, (2, . ir-‘mwxcxcaA t Computer DOpen Book CIGraphlng Calculator 9" (a) Els. ai Drormula Sheet [Periodic Table - Chick-5m ' w I! ‘aper I Open Notes I Basic Calculator Bother: Q: NMCAWX “5 ‘0‘ lg . - ._ Z \A DComputer DOpen Book DOraphing Calculator ‘ -- ' - a - 9.: Eleakal EIFormula Sheet BPeriodic Table CJA who r” I Open Notes I Basic Calculator I Other: I Paper EIOpen Book EIGraphing Calculator DSakai [:1 Formula Sheet El Periodic Table __ _. I Paper I Open Notes I Basic Calculator I Other: 3 'f' DCompuler UOpen Book DGraphing Calculator " '. . ;;_;_.-- Deakal CI Formula Sheet III Periodic Table I Paper I Open Notes I Basic Calculator I Other: ___-“_- j: BS k i Cl Formula Sheet 1:] Periodic Table _ Finariaxainr'lilr'riim'ation __ __ __ _ _ _ _ I Open Notes I Basic Calculator [I'Othen ‘2 \ “t “A. C..\(,\ - I I! 'aper I I Q i “‘3: 3 . W. DOpen Book CIGraphing Calculator .'= ___-“IDS“. DFQWI Sheet WPridrMIe . . .. (”W ’.' . ...
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