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 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:*

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

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

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:

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. • Adjustable table. 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 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.

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.

Add

I hereby agree to abide by the conditions set forth on the current program website, including the Rules of Test Participation in the RICA, 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/Assessment Arrangements Request Form, 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. Because of space, staff, and time constraints, I may not be able to schedule a test appointment with accommodations in my preferred date range. I understand and agree that the alternative 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. Agree*

Please check the box below.

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