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Application Request For Test Accommodations - Texas
| Application Request For Test Accommodations Form. This is a Texas form and can be used in Board Of Law Examiners Statewide . |
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FORM A: APPLICANT REQUEST FOR TEST ACCOMMODATIONS NOTICE TO APPLICANT: This form is part of your request for test accommodations on the bar examination. This form and all other applicable forms and required documentation must be filed at the same time as your application for admission. If additional space is needed to respond to any item, please attach a separate page. Do not leave any blanks or answer "see attached." Full name: _______________________________________________________________________ Date of birth: I. YOUR DISABILITY STATUS 1. Check the disability or disabilities for which you are requesting accommodations, only disabilities noted here will be considered. Learning disability ADHD Physical disability Visual impairment Hearing impairment Psychological disability Other (describe) _____________________________________________________ 2. I was professionally diagnosed with ______________________________ (state specific diagnosis) in _____ (month), _____ (year). This disability is temporary / permanent. 3. The diagnosis was made by: Health care provider: ____________________________________ Type of health care provider: _____________________________________________________ Current address: _______________________________________________________________ Current City/State/Zip: _________________________________________________________ Current phone number:_____________ Fax: __________________ 4. List your age when first diagnosed. ______________ 5. Are you currently being treated? Yes No If yes, provide the name, qualifications, and telephone number of each treating professional. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 10/10/2012 Form A-Page 1 American LegalNet, Inc. www.FormsWorkFlow.com 6. List any treatment and/or medication currently prescribed for the disability or disabilities identified above, or list "none." 7. Is the treatment or medication effective in controlling symptoms? If no, describe remaining symptoms and any side effects. Yes No N/A II. HISTORY OF ACCOMMODATIONS For questions 1 through 5 below, please follow these instructions: If you were granted accommodations, check "Yes." List the condition or diagnosis for which accommodations were granted, the specific accommodations granted, the educational institution or testing agency that granted the accommodations, and the time frame. If you did not request accommodations, check "Not requested." Explain why you did not request accommodations. If you were denied accommodations, in whole or in part, check "Denied." List the month and year the request was made, the condition or diagnosis for which accommodations were requested, the accommodations requested, the educational institution or testing agency, and the reason given by the entity for the denial. Note: if your request for accommodations was granted in part and denied in part, you should check both "Yes" and "Denied." If you did not attend the type of school or take that exam, check "N/A." 1. Did you receive accommodations for the bar examination taken in another jurisdiction? Yes Not requested Denied N/A 10/10/2012 Form A-Page 2 American LegalNet, Inc. www.FormsWorkFlow.com 2. Did you receive accommodations for the Multistate Professional Responsibility Examination (MPRE)? Yes Not requested Denied N/A 3. Did you receive accommodations in law school? Yes Not requested Denied N/A 4. Did you receive accommodations in college (undergraduate or graduate studies)? Yes Not requested Denied N/A 5. Did you receive accommodations for any of the following standardized tests? LSAT MCAT GRE GMAT SAT ACT Yes Yes Yes Yes Yes Yes Not requested Not requested Not requested Not requested Not requested Not requested Denied Denied Denied Denied Denied Denied N/A N/A N/A N/A N/A N/A 10/10/2012 Form A-Page 3 American LegalNet, Inc. www.FormsWorkFlow.com 6. Did you receive accommodations or disabled-student services in high school, including but not limited to accommodations or services provided as a result of an Individualized Education Plan (IEP) or a 504 Plan? Yes Not requested Denied N/A 7. Did you receive accommodations or disabled-student services in elementary or middle school, including but not limited to accommodations or services provided as a result of an IEP or a 504 Plan? Yes Not requested Denied N/A ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ III. ACCOMMODATIONS REQUESTED FOR THE TEXAS BAR EXAMINATION (CHECK ALL THAT APPLY) For each accommodation you are requesting, explain why the accommodation is necessary and how it alleviates the impact of your disability or disabilities in the context of taking the bar examination Test question formats: Braille Audio CD Large print/18-point Specific Rationale: font Large print/24-point font Specific Rationale: Assistance: Reader Court Reporter/Scribe MBE Grid Assistance 10/10/2012 Form A-Page 4 American LegalNet, Inc. www.FormsWorkFlow.com Extra testing time. Indicate below how much extra testing time is requested: Day 1, Segment 1: Multistate Performance Test (MPT) 90-minute writing project (lawyering skills) Recommend: ½ for reading/organizing, ½ for writing Additional time requested 10% 25% 33% 50% Other (specify) _________ Specific rationale for additional testing time on this segment Day 1, Segment 2: Procedure & Evidence Questions (P&E) 90-minute short answer exam Additional time requested 10% 25% 33% 50% Other (specify) _________ Specific rationale for additional testing time on this segment Day 2: Multistate Bar Examination (MBE) 200-question standardized test divided into two 3-hour sessions Additional time requested 10% 25% 33% 50% Other (specify) _________ Specific rationale for additional testing time on this segment Day 3: Texas Essays 12 essay questions in 6 subject areas, divided into two 3-hour sessions Additional time requested 10% 25% 33% 50% Other (specify) _________ Specific rationale for additional testing time on this segment 10/10/2012 Form A-Page 5 American LegalNet, Inc. www.FormsWorkFlow.com Other arrangements (e.g., wheelchair access, elevated table, beverage, food, medication, lamp, magnifying glass, etc.). Describe the arrangement
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