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Alternative Testing Request Form

Wednesday, September 03, 2025

Office of Disability Services
University of Arkansas - Pulaski Technical College
3000 West Scenic Drive
North Little Rock, AR 72118

(501) 812-2738 | [email protected]

 

Reminder: Student must contact DS to schedule an appointment at least 3 days before test date.

Please check any of the following which are allowed for the student to use during testing, if none apply check N/A:
Method for returning test to instructor:
Attach/Upload Test
Add another

 

********* For DISABILITY SERVICES Use Only *********

 

X - Received | D - Student Declined

Testing Accommodations:

(       ) Extended time

(       ) Reduced Distraction Room

(       ) Enlarged Print (            font)

(       ) Reader

(       ) Scribe

(       ) Other:

Date test administered:

Time allowed:            hours             minutes

Start Time:                 a.m. / p.m.

End Time:                   a.m. / p.m.

 

 

______________________________________________________________________________________________
Student SignatureDisability Services Staff Signature
  
  
  
Date e-mailed to instructor:_______________________________________________
 Disability Services Staff Signature
  
  
Date instructor picked-up:_______________________________________________
 Instructor Signature