Special Needs Form

If you plan to come to the Missouri State University-West Plains Community Shelter located at 323 West Trish Knight Street on the Missouri State University-West Plains campus because of a tornado warning for the area and have special needs that we should be aware of, please complete this form as necessary and mail or bring to:

Scott Schneider, Director of Business and Support Services
Cass Hall, Room 104
Missouri State University-West Plains
128 Garfield Avenue
West Plains, MO 65775

Missouri State University-West Plains will accommodate, to the best of our ability, your special needs once you arrive at the shelter. The University cannot provide any services to you that are required off campus such as transportation to and from the shelter.

Name Street Address Phone Email
(Please print) Special Needs (Medical alert, wheel chair or walking aid required, electric plug-in, etc.)Please explain briefly:Note: There are ADA restrooms located in the shelter.

If you require the aid of a service animal (such as a guide dog) and want to bring it to the shelter with you, the following is required. Please check the appropriate box:

 I require a service animal  N/A

The service animal must remain leashed or harnessed. You should prepare an evacuation kit for your service animal and bring it with you. Items to include in Emergency Evacuation Kit:

  • Animal Identification (tag on collar/harness, microchip)
  • Water and drinking bowl if desired
  • Cleaning supplies for animal waste (wipes, disinfectant, garbage bag)
  • Leash, collar or harness
  • Medications (if animal is on medication)

Note: You will be responsible for the actions of your service animal.