The Ohio State University at Mansfield

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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 (*)
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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 (*)
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Materials specifications
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Test Delivery Method (*)
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Test Return Method (*)
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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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