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Instructor's Test Accommodation Form
Please fill this form out accurately and completely. Please call 417-659-3725 if you have any questions. Fields marked * are required.

*Name of Student: 
*Instructor: 
*Course Name: 
*Course Number: 
*Amount of time given to class to complete the exam (ex: 1 hr 20 min): 
*Day class is scheduled to take exam:
*Date class is scheduled to take exam: 
*Time class is scheduled to take exam: 
*AM/PM:
*Do you permit student to take exam at a
time other than what is indicated above?
*Please include your phone number and email so that we may contact you if we have questions: 
Please check all items below that pertain to the exam
Blue Book
Open Book
Open Notes
Scantron
Scantron Type: 
Computer
Calculator
Choose one:
Notes must be turned in with exam
Special Instructions (Limit to 4000 characters): 
How will Student Success Center receive test?
*Choose one
 
Password for Online Test 
Please Note: If student has an accommodation of "audio formatted tests", an e-mail with the test attached, in Word or PDF format, must be provided to the Student Success Center at least one day prior to the test date.
Return Instructions:
*Choose one:
Sign with MSSU Username and Password
By submitting this form with Username verification I acknowledge that all the information on this sheet has been approved by me and that I am aware of the testing guidelines that are enforced by Disability Services.
Employee Username
Password