Request for Special Accommodations Individuals having a disability requiring special accommodations must complete this form. Supporting evidence (e.g. letter from a licensed physician or other applicable professional, on letterhead, addressing the stated disability and need for the requested accommodation) must be submitted at least 30 days prior to the desired test date. Reasonable accommodations provide candidates with documented disabilities, as defined by the Americans with Disabilities Act (or the Canadian/Australian equivalent), a fair and equal opportunity to demonstrate their knowledge and skill in the essential knowledge being measured by the examination. Reasonable accommodations are determined based on: the individual’s specific request; the individual’s specific disability; documentation submitted; and, the appropriateness of the request.” Requests are decided upon an individual basis. Approved accommodations will be provided by the testing vendor or the approved proctor. Accommodations usually include an allowance for increased examination time. Accommodation requests will be acknowledged through email and/or phone notification within 7-10 business days of the initial request. For individuals who require a reader, separate accommodations, or other requirements please state your needs and requirements in detail below. Requests will be considered and a response will be delivered within 10 business days. The most common requests are for: Extended time – typically either time and a half or double time. Double time is the maximum allowable time. Reader – oral readers can be arranged for candidates. When a candidate is assigned a reader they will need a private room or a closed session. Paper & Pencil –paper & pencil exam requests (normally to have larger font due to vision) must be scheduled at least 10 days out to allow for a physical copy of the exam to be mailed to the site. Private Room – a private room (or closed/created session) can be arranged for a candidate. 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Please name the PSI center at which you wish to take your exam.Please provide three preferred testing datesDo you prefer a morning or afternoon session? Morning Afternoon Reason for request (provide evidence/justification in a few sentences)(Required)Accommodation RequestedExtended timeReaderPaper & PencilPrivate RoomUpload supporting documentation (mandatory)(Required)Accepted file types: pdf, jpg, gif, png, Max. file size: 10 MB.Special Accommodations Site Fee Quantity(Required) Price: $45.00 Quantity Upon clicking the Submit button below, you will be redirected to the payment site. If payment is not completed within 24 hours of submission, your submission will not be processed. Total