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Instructor's Test Accommodation Form
Please fill this form out accurately and completely. Fields marked
Name of Student:
Time given to class (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:
Do you permit student to take exam at a
time other than what is indicated above?
If the student has questions during the
exam, how may we contact you?:
Please check all items below that pertain to the exam
Notes must be turned in with exam
Special Instructions (Limit to 4000 characters):
How will Student Success Center receive test?
Instructor drop off in Student Success Center
FAX test over (Ext. 4456)
Email: email@example.com Cc: firstname.lastname@example.org
File upload (.doc; .docx; .pdf format)
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.
Instructor pick up from Student Success Center
Student Success Center returns to instructor within 24 hours
Verify and Submit
By submitting this form with SID 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 DSS.
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Joplin, MO 64801-1595
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