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Request an Exam Proctor

The form below is to be completed by the student who receives accommodations through the Office of Disability Services. A copy of the request will be sent to the professor. Students should first contact their professor to see if they can proctor the exam. If the professor is unable to proctor the exam, please verify with your professor the in-class duration of the exam and the acceptable date and times to complete the exam. Keep in mind that our office is open Monday-Friday 8:30-4:30 and all proctored exams occur during those hours. Please note that this form must be completed accurately and must abide by the Office of Disability Services testing policy which states that the student must provide the office with at least a 4-5 business day advanced notice.

Please fill in all fields:

Full Name:
Your Holy Cross E-mail:
Class Name (as it appears on the schedule):
Course Name (as it appears on the schedule):
Professor Name:
Your Professors Holy Cross E-mail:
Professor Office Number (as it appears on the syllabus):
Classroom Location (as it appears on your schedule):
Duration of the in-class exam:
Date the class is scheduled to take the exam:
Exam time approved by professor1:
List of accommodations needed for the exam:

I have spoken to my professor and they have approved my request to take their exam on the date and time I have listed in this form.
I understand

Please note: Submitting the form does not solidify a test date. After Disability Services coordinates your exam details with the proctor, a confirmation email will be sent to your Holy Cross email explaining the date, time and location of your exam.
I understand

I acknowledge that the information I have provided is correct:
I understand


1If you have a class immediately before or after this exam, Disability Services will schedule your exam with accommodations without interfering with your other class. If you have a class prior to this exam your extended time will be applied at the end of the scheduled test time. If you have a class after this exam your extended time will be begin prior the class start time. You will receive a confirmation email with the specific exam times.