exam scheduling request - bcit · exam scheduling request disability resource centre 3700...
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EXAM SCHEDULING REQUESTDisability Resource Centre3700 Willingdon Avenue, Burnaby, BC, Canada V5G 3H2E [email protected] T 604.451.6963 F 604.432.8839
Building SW1-2360
DR
C-10
_V3
(201
6:02
)
Notes to Students:
> Submit a separate Exam Invigilation Request for each exam at least five (5) working days before the class exam date. > Students are encouraged to write exams during the Disability Resource Centre’s (DRC) operating hours, 8:30–4:30, excluding weekends and statutory
holidays. To request special arrangements outside the DRC’s normal operating hours, see the DRC. > Contact the DRC at the above phone number for questions or concerns. > When completed, e-mail, fax, or print and bring in person to the DRC.
STUDENT (COMPLETE THIS SECTION ONLY)
Student’s Name (First Middle Last) Instructor’s Name Today’s Date
Student Number Instructor’s Phone Number or E-mail Address Exam Type (Check one only)
Quiz Mid-term Final
Student’s Phone Number My Individual Accommodation Plan (green sheet) is updated for this term.
Course Title and Number (e.g., CHEM 1101)
Requested accommodations for this exam are: (check “Yes” only to approved accommodations)
1½ Time 2.0 Time
Compensatory time
Individual room
Computer
D2L/internet access
Share In/Out access
Reader
Scribe
Specialized software
Class Date Exam Time Other Approved Accommodations/Instructions
Requested Date Requested Time
INSTRUCTOR (PLEASE NOTE: NO INTERNET AVAILABLE)
Allotted time for exam in class: ____________ minutes. Closed book Open book
Calculator Permitted Not Permitted Not required Type of calculator Any Non-programmable
Formula Sheet Included Permitted Not required Type of formula sheet
Cheat Sheet Permitted Not Permitted Not permitted/Not required Type of cheat sheet
Dictionary Permitted Not Permitted Not required Type of dictionary Book Electronic
Scan back completed exam
Pick up
Additional Instructions
DRC OFFICE USE ONLY
IAP is Current and Exam Accommodations Confi rmed 1st Request E-mail Date Sent
2nd Request E-mail Date Sent Exam Scheduled 3rd Request Phone Call Date Made
Class Exam Time Length (hours x.x) X Accommodation Factor = Total Exam Time
Exam Start Time Exam End Time
Exam Picked Up By (signature) Date Exam Picked up Exam Room Number
BCIT collects the personal information that you chose to provide on this form under the authority of section 26 of the Freedom of Information and Protection of Privacy Act RSBC, 1996, c. 165 and the College and Institute Act, RSBC, 1996, c. 52.
This information will be used only to determine your eligibility for academic accommodations, and if eligible, to provide the appropriate accommodation. BCIT will not disclose your personal information to a third party or a BCIT program area outside of the Disability Resource Centre without your consent unless required by provincial and or federal government authorities or authorized by law.
Questions about the collection, use and disclosure of personal information by BCIT may be directed to the Associate Director, Privacy, Records Management and Copyright, 3700 Willingdon Ave., Burnaby BC V5A 3H2; Tel: 604.432.8508 Email: [email protected]. Directory of Records Classifi cation 3565-20.