Testing Request Form

First Name

Last Name

Hilbert email address

Course

Professor

Please check all that apply:

Class Time
Electronic document required
Computer required for test
Internet Access required
Read & Write / Kurzweil
Dragon Naturally Speaking
Dragon Naturally Speaking

Date of requested test (01/01/2016)

Start Time of Test

How much time is needed? (ex. 75min., 2hrs, etc.)

I understand that my appointment is not finalized until I receive confirmation from Academic Services based on availability.

Yes
No

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