Banacos Exam Reservation Form

**Reservations should be made at least 2 business days prior to the exam**

**Requests for Readers, Scribes, Screen Readers, Speech to text, or Rooms Alone must be made 5 business days prior to exam**

The exam room is located in the Banacos Academic Center. The Banacos Academic Center is located in the annex of Parenzo Hall (next to the gym and across from the Bistro)

Today's Date:	*
First Name	*
Last Name	*
UWID (A#):	*
Student Cell # (ex: 555-555-5555)	*
WSU Email	*
Are you registered to receive accommodations?	* If no, please see the Access Advisor	Yes No
Course Number (i.e. MATH 0111):	*
Professor:	*
When is your class?
Days (i.e. MWF, TR, MW, etc)	*
Time	*
Exam Date:	* If this date is different than the date your class will take the exam, you will need to have your professor's written permission to take it on that day.
Time you will start your exam (i.e.; 8:15 a.m.):	* If this time is different than your class time, you will need to have your professor's written permission to take it at a different time.
Which accommodations will you need for this exam?	They must be approved by your Banacos Academic Center Advisor
		Extended time
		Calculator
		Computer
		Other
		Formatting (larger font, spacing, etc.)
Do you need a reader?	*	Yes No
**If you need a reader:		Screen reader (Kurzweil)
		Please find me a reader
Do you need a scribe?	*	Yes No
**If you need a scribe:		Speech to text
		Please find me a scribe
How will the exam get to the center?	* **if the exam is on PLATO, please check off that you will be bringing the exam	Exam Room staff should contact the professor My exam is online (PLATO) (**be sure to bring your laptop) Professor asked me to bring the exam here
To be completed by examroom staff: