On-campus accommodated test request form To schedule an on-campus accommodated test, please complete the form below. Test Requests Please fill out one form for EACH exam you are booking. Please do not put multiple dates on one form.Full name* First Last Student number* Student's email address* Student's telephone number*Exam type* Paper Online Approved accommodations*Select only your approved accommodations needed for this test. Extra time Computer use Dragon use Read and write Other If you selected other, please specify Program* Please enter the program you are enrolled in.Course code* Campus*Accommodated Georgian students must write at the same time and on the same campus as classes. Barrie Midland Muskoka Orillia Orangeville Owen Sound South Georgian Bay Faculty's name* First Last Faculty's email address*Please ensure this address is correct before submitting. Date of test in class* MM slash DD slash YYYY Start time of class test* Hours : Minutes AM PM Time of test request.Time given for class to complete the test*Do not add extra time. 15 minutes 30 minutes 50 minutes 1 hour 75 minutes 1.5 hours 2 hours 2.5 hours 3 hours Special circumstances and additional informationTell us about any special circumstances required for this test.Notice of CollectionGeorgian College is compliant with the Freedom of Information and Protection of Privacy Act (FIPPA), and endeavours to protect your personal information in accordance with this law. The personal information requested on this form is collected under the legal authority of the Ontario Colleges of Applied Arts and Technology Act, 2002 and in accordance with Sections 38(2) and 41(1) of FIPPA. The information provided will not be used for any other purpose than to assist you with the testing process. For more information about FIPPA, please contact the Access and Privacy Office at 705.728.1968, ext. 5770 or [email protected]CAPTCHAEmailThis field is for validation purposes and should be left unchanged.