Alternative Testing Arrangements Request Form

A red asterisk * indicates a required field.

Alternative testing arrangements may only be applied to unscheduled test registrations.

Prior to submitting this form: • Register for the test(s) for which you are requesting accommodations. • Do not schedule your appointment. If you did schedule a test date, please cancel your appointment before completing and submitting this form.

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

Identify the disability 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. • Use of a trackball mouse. • Screen magnifier. • Large font (up to 200%). 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 have had an adequate opportunity to review, to my satisfaction, the FTCE/FELE website and hereby agree to abide by the conditions set forth on the website and I certify that I am the person whose name and address appear on this form. I am submitting, together with this completed Alternative Testing Arrangements Request Form, any required documentation as noted on the website. If my institution is submitting an Institutional Verification of Documentation on my behalf, I authorize that institution to submit a copy of the documentation referenced on that form to Evaluation Systems upon request. I understand that the information I provide, including any supporting documentation, may be shared with the DOE in order to process my request. 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(s) 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.