Center: Student with laptop computer; Right: Entrance to Old Main.
Testing Accommodation Form
Accommodations & Services
Policies & Procedures

STUDENT FORM

INSTRUCTIONS: Please provide all information requested on this form. Steps 1-6 must be filled out completely. Step 7 is optional. Then submit your request. You are also required to fill out a Proctor Checklist form and submit this to your professor one week in advance. Once you have clicked "Submit Request", you will automatically be taken to a link where you can print out the Proctor Checklist form.

If you have any questions, please contact Anne-Marie Dobies, at dobies@canisius.edu or by calling (716) 888-3748. 

Requests should be submitted one week in advance.

1.) Student Information:
Name:
ID #:
E-mail:
Phone:
2.) Professor Information:
Name:
Office:
E-mail:
Phone:
3.) Course Information:
Title:
Number:
Section:
4.)
Start Time:
End Time:
Test Information:

5.) Please check one:
Test is scheduled to begin at the same time as the class.
Test is NOT scheduled to begin at the same time as class.
6.) Date:
7.) Additional Note to DSS: