Mathematics Lab | SDSextendedtimeonly

INSTRUCTOR'S Name * First Last

INSTRUCTOR'S Email Address *

Instructions Please fill out the form completely for each student.

STUDENT'S Name * First Last

STUDENT'S Email Address *

Course *

Math 115Math 120Math 121Math 167Math 267Math 268

Section *

01101802111903122004132105142206152307162408172509

Does the student receive extended time on tests? *

Yes

How much extended time? *

1.5x2.0x2.5x

Are there any other TESTING accommodations (NOT REDUCED-DISTRACTION ENVIRONMENT)? *

YesNo

Please state the other TESTING accommodations.