Assessment Center: Test Accommodation(s) Request Form

Assessment Center Test Accommodation Request

If you have an approved accommodation, please complete this form to request an accommodated test in the Assessment Center, CLC-107. You must send your Approved Accommodation Letter to testing@brazosport.edu before your scheduled exam appointment.
I have previously been granted special testing accommodations with Brazosport College:
Student Information
BC Student ID:
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name

First NameMiddle NameLast Name
Email
The e-mail address for your BC Student email account is your username@brazosport.edu
Daytime Phone Number
Format: (000) 000-0000.
Evening Phone Number
Format: (000) 000-0000.
Test Information
1. Complete this form to request an accommodated test 48 business hours prior to the requested exam date.
2. If exam fee is required, complete the appropriate exam registration form at www.brazosport.edu/assessmentcenter.
3. Check your BC email for registration confirmation.
Test I am requesting accommodations for:

Other
If TSIA2, please indicate the subjects you will be taking.
List the specific testing accommodation(s) requested:

Other
If any or all special accommodations I am requesting are denied, I would like to be registered under standard conditions.
Request a Test Date in the Assessment Center

To schedule your accommodated test, please complete the Assessment Center: Proctored Exam Registration Form to reserve an Accommodated Test Room.

Please note, if you are taking an exam that requires an exam fee, you will need to complete the appropriate registration form at www.brazosport.edu/assessmentcenter.

This form must be submitted at least 48 business hours prior to your requested test date. This allows the Assessment Center sufficient time to coordinate any required accommodations, materials, and support for your exam.

After submitting your registration form, you will receive a confirmation email sent to your BC email.

Please contact the Assessment Center at (979) 230-3253, if you have any questions or email them at testing@brazosport.edu.
Option 1: Requested Test date/time:
Option 2: Requested Test date/time:
ELAR: Requested Test date/time:
Math: Requested Test date/time:
Retest Essay Only: Requested Test date/time:
Retest ELAR Multiple-Choice Only: Requested Test date/time:
Option 1: Requested Test date/time:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDateHourMinutesAM/PM Option
ELAR Test Date:
Math Test Date:
Retest Essay Only Test Date:
Retest ELAR Multiple-Choice Only Test Date:
Student Certification

By checking this box, I certify that I am the person whose name and address appear on this form. I am submitting, together with this completed Testing Accommodations Request form, any required documentation as requested by the Counseling and Testing department. I understand and agree that the special accommodations I have requested herein will be given due consideration. If, and to the extent that, any such request is granted, I understand that I will be taking the test under special conditions.
Print Name
Signature
Should be Empty:

Assessment Center Test Accommodation Request

Student Information

Test Information

Request a Test Date in the Assessment Center