Late Exam Request Form PLEASE FILL OUT THE FOLLOWING:Student Name(Required) First Last Email(Required) Please select your campus:(Required) Storrs Hartford Stamford Avery Point Waterbury Course and Section Number(Required)example: CHEM 1127Q.001Instructor(Required)Instructor Email(Required) Date class is taking exam(Required) MM slash DD slash YYYY Time class is taking exam(Required) Hours : Minutes AM PM AM/PM Duration of assessment in class(Required)Date you are requesting to take exam(Required) MM slash DD slash YYYY should be the same as the class unless you have instructor permission to take on an alternate day/timeTime you are requesting to take exam(Required) Hours : Minutes AM PM AM/PM Note: If this is an alternate date/time than the class, you will need instructor approval. Do you have approval?(Required) Yes No N/A If requesting the same date/time as the class, select N/A.Please explain and/or forward approval to csdexams@uconn.edu. If requesting the same date/time as the class, type N/A in the box below.(Required)Accommodations you would like to use(Required)Academic Integrity Acknowledgement(Required) By checking this box and submitting my scheduling request, I understand the bullet points below.· I am responsible for following all procedures at the Center for Students with Disabilities (CSD). · I will be required to place ALL unauthorized materials, as indicated by my instructor and the CSD, (such as cell phone, ear buds, and smart watch) in a locker upon check-in. · Possible academic misconduct will be reported to my instructor and the Office of Community Standards. · Any academic misconduct as defined by UConn’s Academic, Scholarly, and Professional Integrity Misconduct Policy, and the Student Code, may impact my eligibility to take exams at the CSD in the future. DSP(Required)Select your DSP from the drop down menuBryanna AndersonChristine WenzelChristopher ScottErica ConklinErica KlimekJennifer LuciaKatie HalbrunerLindsay WellsMegan NemeroffRachel JulianTerran TuretskyI don't knowPhoneThis field is for validation purposes and should be left unchanged.