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Application Form For Special Testing Accommodations - Rhode Island
| Application Form For Special Testing Accommodations Form. This is a Rhode Island form and can be used in Admission To Rhode Island Bar Supreme Court Statewide . |
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RHODE ISLAND SUPREME COURT BOARD OF BAR EXAMINERS LICHT JUDICIAL COMPLEX 250 BENEFIT STREET PROVIDENCE, RI 02903 TEL (401) 222-4233 (INFORMATIONAL LINE) APPLICATION FOR SPECIAL TESTING ACCOMMODATIONS FORM A This form must be filed with your application to take the Rhode Island Bar Examination. For a medical disability, complete and return the Eligibility Questionnaire (Form A) and the Medical Disability Verification (Form B) with your completed Application for Admission. For a learning disability, complete and return the Eligibility Questionnaire (Form A) and the Learning Disability Verification (Form C) with your completed Application for Admission. For exam in Name: February July of ________________________. Date of Birth: __________________ State: ____________ ___________________________________________ Home Address: Home Telephone: _____________________________ City: ____________ _______________________ Visually Impaired Learning Disability Email: ____________________________________ Hearing Impaired Other Other Physical Disability Nature of your disability: Psychological Disability _________________________ Describe the nature and extent of your disability: ________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ How long have you had the disability: less than 1 year 1-3 years 4-6 years Yes Yes Yes Yes 6+ years No No No No Were past accommodations granted in college/law school for your disability? Did you receive accommodations for classroom tests? Did you receive additional testing time for classroom tests? Were you granted testing accommodations for the LSAT or MPRE? If you answered yes to any of the above, please explain the accommodations: ________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ BBE STA 08/07 American LegalNet, Inc. www.FormsWorkFlow.com Please check the accommodation(s) that you believe are necessary for you to take the Rhode Island Bar Examination: Braille version of test Large print for test book Audio version of test Use of tape or digital recorder Use of a reader Additional testing time (Amount: ____________) Other (Please explain: ____________________________________________________________________) By signing this form and submitting this request, it is possible that the Board of Bar Examiners may wish to contact your treating physician(s) to verify medical information concerning you as part of your request for a special testing accommodation. The release of such information by your treating physician(s) requires your informed consent. You can withhold your consent if you wish, but if it is refused, the Board of Bar Examiners may have to make decisions without the benefit of verified information from your treating physician(s). Please make your choice by signing either Option 1 or Option 2. OPTION 1 I give permission for my treating physician(s) to provide information on my medical condition to the Board of Bar Examiners. I understand that the information will remain confidential to the Board of Bar Examiners and that the information will be used only to verify my medical condition relating to my request for special testing accommodations. SIGNATURE: ___________________________________ DATE: _____________ OPTION 2 I refuse to allow consent to contact my treating physician(s) to verify my medical condition relating to my request for special testing accommodations. SIGNATURE: ___________________________________ DATE: _____________ If you are unable to sign this form, please have someone sign it and date it in your presence on your behalf. Signature of person signing on behalf of applicant: Date: ____________________________________ ___________________________ The Rhode Island Board of Bar Examiners reserves the right to make a final determination concerning testing accommodations and may have this information reviewed by a medical professional, psychologist, or learning disability professional. BBE STA 08/07 American LegalNet, Inc. www.FormsWorkFlow.com RHODE ISLAND SUPREME COURT BOARD OF BAR EXAMINERS LICHT JUDICIAL COMPLEX 250 BENEFIT STREET PROVIDENCE, RI 02903 TEL (401) 222-4233 (INFORMATIONAL LINE) APPLICATION FOR SPECIAL TESTING ACCOMMODATIONS FORM B MEDICAL DISABILITY VERIFICATION To be completed by a physician or licensed medical professional. The Rhode Island Board of Bar Examiners requires current (within the last five (5) years) documentation from a physician or other license professional in the field related to the applicant's disability to be included with a request for special testing accommodations. The Applicant must return this form with his/her completed Application for Admission to the Bar of Rhode Island. Please type or print legibly the following information. Applicant's Name: _________________________________ Date: ______________________________ Name of Physician/Licensed Professional: Address: ______________________________________________________ City: _________________ State: ____________ Email: ____________________________________ Title: ____________________________________________________________________________________ ______________________________ Telephone Number: ________________________ Last date of treatment/consultation with applicant: ________________________________________________ Please describe your credentials that qualify you to diagnose and/or verify the applicant's disability and to recommend an accommodation: ____________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ What is the specific diagnosis, condition, or physical impairment that requires testing accommodations: ______ __________________________________________________________________________________________ _______________________________________________________________________
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