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**

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	* If this time is different that your class time, you will need to have your professor's written permission to take it at a different time.
Exam Date:	*
Time you will start your exam (i.e.; 8:15 a.m.):	* **If this is a time other than your class time, we must have your professor's permission
Which accommodations will you need for this exam?	They much 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: