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Application for Special Exam Accommodations
This form is designed for students of the Faculty of Mathematics and Natural Sciences. The form is not designed for students of service courses.

First name:Surname:
ID number:Year of degree studies:
Phone:Email:

Degree:
Teaching program:

I require exam accommodations on the basis of confirmation from the Unit for Evaluation and Support of Students with Learning Disabilities/Accessibility Unit/Parenting and Gender for the academic year 2018/19.
Mark the relevant accommodation
Quiet room / few examinees / separate
50% extended time
Having the exam questionnaire read aloud (arrangements for the reading aloud will be made directly with the Unit for Evaluation and Support of Students with Learning Disabilities)
Larger-print exam questionnaire
Computer
Reproduction (arrangements for reproduction will be made directly with the Unit for Evaluation and Support of Students with Learning Disabilities)
Other
Detail

Course details
Course number:Course name:
Exam period:
Exam date*:
בחר תאריך מתוך לוח השנה.
Exam time:
*Requests without an exam date will not be considered
Halls:

No file selected
The file must be in PDF format

I undertake to inform the exam department 48 hours in advance of my non-participation in a particular exam.
The notice should be sent to email mayaab@savion.huji.ac.il
I hereby confirm that all the above information is correct