Alternative Testing Arrangements Request Form

A red asterisk * indicates a required field.

Prior to submitting this form: • Register for the test(s) for which you are requesting accommodations.

Candidate ID Number:*

(Found in your registration account)

First Name:*

Middle Initial:

Last Name:*

Last 5 digits of Social Security Number:*

Email:*

Confirm Email:*

Mailing Address:*

Address Line Two:

City:*

State/Province/Region:*

Zip/Postal Code:*

Country:*

Daytime Phone:*

Evening Phone:

Test(s) for which you registered: *

Current Characters (Max 500): 0

Test date for which you registered

Identify the basis for which you are requesting alternative testing arrangements:*

Current Characters (Max 500): 0

List the specific alternative testing arrangement(s) that you are requesting (please note: only the requests listed will be considered):*

Current Characters (Max 1000): 0

If you plan to bring a medical device into the testing room, please provide the make and model of any device(s) you intend to bring:

Current Characters (Max 500): 0

Documentation (check one of the following)*: I am requesting one of the alternative testing arrangements listed below because of a disability. Medical documentation is not required for the following accommodations: • Allowance of a medical device in the testing room. • Wheelchair-accessible facilities. • Frequent breaks (e.g., for those with hypoglycemia or diabetes). • Use of a magnifying glass, color overlays, or a straightedge (e.g., for those with a visual impairment). • Use of a pen for a written assignment (e.g., for those with a motor impairment). • Written copy of the oral directions (e.g., for those with a hearing impairment). I am requesting alternative testing arrangements other than those listed above. Therefore, I have enclosed documentation, if required, as indicated on the current program website. I am requesting alternative testing arrangements other than those listed above. My institution has a copy of my documentation on file, and I am only requesting accommodations listed in section 8 of the Institutional Verification of Documentation Form. Therefore, I have submitted an Institutional Verification of Documentation Form, completed by an appropriate institution representative. I have been approved for alternative testing arrangements for this testing program in the past. The accommodations I am requesting and the condition of my disability have not changed. Therefore, the documentation I have previously submitted may be used.

Previous Alternative Testing Arrangements (check one of the following)*: I have not previously been granted alternative testing arrangements. For a previous test session, I was granted the same alternative testing arrangements as I am currently requesting. For a previous test session, I was granted different alternative testing arrangements from those that I am currently requesting.

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I hereby agree to abide by the conditions set forth on the current program website, including the Rules of Test Participation, and I certify that I am the person whose name and address appear on this form. I have completed my test registration and submitted correct payment. I am submitting, together with this completed Alternative Testing Arrangements Request Form for Paper-Based Testing, any required documentation as noted on the website. I understand that the information I provide, including any supporting documentation, may be shared with the CTC in order to process my request. I understand that the deadline for submission of these materials is the regular registration deadline and that, because of space, staff, and time constraints, there can be no assurance that requests received after this deadline can be accommodated. I understand and agree that the alternative testing arrangements I have requested herein will be given due consideration. If, and to the extent that, any such request is granted, I understand that I will be taking the test under alternative conditions. I understand that once I have submitted my supporting documentation, those materials will be used by Pearson to process my request and will not be returned to me.
Agree*

Please check the box below.

Please note, this form must be submitted with each registration.