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Test Request Form
(*) denotes required element
Student Name (*)
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Instructor (*)
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Student Phone (*)
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Instructor Email (*)
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Student Email (*)
Please submit a valid email
Course (*)
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Test Date (*)
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Start time and End time (*)
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Additional time allowance (*)
Normal time
Time and a half
Double time
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With the exception of adaptive computer software necessary to compensate for a disability, your student will only be allowed materials authorized by you.
Materials (*)
Carmen access
Internet access
Textbook
Notes
Formulas, charts, or graphs
Dictionary
Calculator
Scrap paper
Blue book
Computer files and/or software
Scantron needed
Nothing allowed except test and writing utensil
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Materials specifications
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Test Delivery Method (*)
I will deliver the test to ODS.
I will email the test to Michelle McLane.
I will fax the test to 419-755-4016.
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Test Return Method (*)
Place the test in my Ovalwood or Bromfield faculty services mailbox
I will pick up the test at ODS (Conard Learning Center)
E-mail the test back to me
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Date Today (*)
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Thank you for your time in filling out this form. If you have any questions or concerns, please do not hesitate to contact Michelle McLane, Disability Specialist, at 419-755-4304.
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