The scanned version of the sample RITA form contains the following text.
Please print, press firmly, use ballpoint pen.
The student has presented me with a CSD Student Accommodations Form. I agree to the testing accommodations specified. Exams are to be administered by CSD on the following dates and start-times. Note: If start-times are negotiable (within CSD hours of operation) place an (N) in the space designated for time.
Exams must be available or delivered to CSD a minimum of 24 hours in advance of test date.
I understand that exams will be returned to my department location, by CSD, within 48 hours of completion.
Student may use the following aids during this exam:
University of Houston
Justin Dart, Jr. Center for Students with DisABILITIES (CSD)
CSD Building, Room 100 (Building #568)
Houston, TX 77204-3022
Mail Code: 3022
Hours: 8-5 Monday-Friday
Fall and Spring: 8-7 Monday and Tuesday