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.

(Found in your registration account)

Current Characters (Max 500): 0

Current Characters (Max 500): 0

Current Characters (Max 1000): 0

Current Characters (Max 500): 0

Documentation (check one of the following)*: • Allowance of a medical device in the testing room. • Use of a trackball mouse. • Adjustable table.
Previous Alternative Testing Arrangements (check one of the following)*:

Upload Your Files
  1. Preview your files before uploading. Ensure they are legible and complete.
  2. Click “Add” and select a file to upload.
  3. Continue adding files as needed, up to ten files totaling no more than 20 megabytes.
  4. To remove a file from the queue, click the “X” next to the filename.

I state the following under the pains and penalties of perjury. I have read the current MTEL® program website and hereby agree to abide by the conditions set forth on the 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 Computer-Based Testing, any required documentation as noted on the program website. If my institution is submitting an Institution’s 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 Department of Elementary and Secondary Education in order to process my request. I understand that Evaluation Systems reviews all requests for alternative testing arrangements as they are received and makes decisions on each request on a case-by-case basis. However, because of the time it takes to adequately review requests, and because of test center and staffing constraints, Evaluation Systems cannot guarantee that requests can be accommodated on the preferred date or at the requested test center. 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.

Please check the box below.

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