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  Disability Services - Test Notification Form

     This form is for students who receive testing accommodations through the Disability Services Office.  The Disability Services encourages faculty to provide test accommodations within their own department.  However, if it is necessary for the student to use Disability Services for exam proctoring to have the accommodation of extended test time, testing in a distraction-reduced environment, test reader or scribe, then you, the student is responsible for meeting with his/her professor for EACH test and make arrangements then. To schedule the exam in the Disability Services Office, the exam must be scheduled 3 to 5 BUSINESS days (Monday thru Friday)  in advance of the test.  It is necessary for you to find out and include how the Professor is going to send the test to our office and (Return test by) how the Professor is going to send the test to our office (Receive test by) and how the Professor wants the test returned to them (Return test by). Be sure to remind the Professor the class before each exam, as a reminder for the professor to submit the exam to our office!! When scheduling a test (s) please allow time, to 'complete' the test by 4:30 p.m., our offices closing time. You will need to speak to your professor for written permission (to be sent with the test) and note the permission in the comment area below.                                                                                                                                                                                                                                                                                              

First Name:  Last Name:    


Please list/insert the class information exactly as it is listed on your schedule.






I will require a:

Distraction Reduced Environment    Computer

Scribe                                             Reader

Extended Time

Receive test by:

Return test by:  


Please press submit only once.

Kutztown University

15200 Kutztown Road • Kutztown PA. 19530
Kutztown University of Pennsylvania • P.O. Box 730 • Kutztown, PA 19530
(610) 683-4000 • TDD (610) 683-1315, (610) 683-4499
Member of Pennsylvania's State System of Higher Education

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