MTTCPBT

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.

(Found in your account)


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 have read the current program website and hereby agree to abide by the conditions set forth, 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 program 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 MDE 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(s) under alternative conditions.



Please check the box below.

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