Academic Advising

Exam Relocation Form

Please complete this form if you are requesting that an exam or quiz be taken at the Office of Disability Services.

You must complete this request form five (5) days before a quiz or an exam.

Failure to complete this form will result in you not being able to take your exam in the Office of Disability Services.

When you arrive at the Office of Disability Services to take your exam, you will be asked to leave your backpack, coat, phone, IPOD, PDA, laptop, flash drives, books, notes or any other type of bag you may have. Your items will be place in a safe and locked area and will be returned to you after you have completed the exam.

Personal Information:

Student's Full Name:
Clark Email Address:
Clark ID Number:
Phone Number:

Exam Information:

Course Title:
Course Number:
Date of Exam:
Time of Exam:
Professor's Name:
Computer:	If your accommodation explicitly states the use of a computer, please indicate if you will need a computer for this exam. Yes No