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Proctor Request Form

  1. Student Support
  2. Office of ACCESSibility
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  4. Proctor Request Form
Proctor Request Form

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We require at least 7 days notice to guarantee the accommodation.

We will still accept late forms and will make every effort to accommodate, we just cannot make any guarantees without a week's notice.

Please do not submit forms more than 2 weeks in advance.

STUDENT SECTION

Requested Accommodations

Requested Accommodations *
I have read and understand the rules and protocols for using testing services with The Office of ACCESSibility.*

PROFESSOR SECTION

FOR PROFESSORS TO FILL OUT ONLY.

STUDENT, DO NOT FILL OUT THIS SECTION.

The professor should fill out a hard copy and give it to the student to upload.

OR

The professor should fill out the digital form below.


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If your professor filled out the paper version of the Professor Section, please upload it here.
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Professor Information

Exam Information

Date and time of exam*
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Will lecture resume after the exam?*

Due to limited hours, it may be necessary to arrange testing at an alternative date/time than the regular class exam.

  • Dobbs Ferry available testing hours: 9 AM–5 PM, Mon–Fri or by appointment
  • Bronx and Manhattan by appointment
Please indicate an alternative date and time to take the exam:
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:
How will professor deliver exam to ACCESSibility Office? *
How will professor retrieve completed exam? *
Example: calucalator, scratch paper, formula sheet, etc.
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We believe if colleges were more open, people's minds would be more open, too. Because if all kinds of students got degrees, all kinds of people would have new opportunities. And with every new opportunity, the world transforms. Not every institution believes in this vision, but we do. The world isn't made for Mavericks, but Mercy is. Come join us.

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