Request for Special Testing Accomodations

Request For Special Testing Accommodations 2020 The National Dental Assisting Examining Board may provide special testing accommodations for applicants with special needs or for candidates requesting an alternate sitting date for religious reasons. The Request for Special Testing Accommodations Form and supporting documentation must be received by the application deadline. Late or incomplete requests cannot be granted. I ________________________________________ request the following special sitting (print your name) accommodations for the NDAEB written examination or clinical practice evaluation scheduled for: __________________ (yyyy-mm-dd) Select the requested special testing accommodations from the list below: Separate room Extra time (time and one half = 6 hours) Exam reader Recorder* Alternate date for religious reasons Prayer time(s) for the written exam and/or Clinical Practice Evaluation Other (eg. Kurzweil – explanation and proof of requirement supported by a psychologist, etc. required) I have enclosed the following documents which support my request: Report explaining my learning disability and recommended accommodation(s) completed in the previous 5 years by a psychologist / learning disabilities specialist Letter from my physician written in the past year explaining the nature of my disability (other than learning disability) Letter from religious leader written in the past year confirming the need for an alternate sitting date for religious reasons (Note: alternate sitting dates for religious reasons will usually be scheduled for the Friday before the national exam sitting date.) Letter stating the time(s) required for prayer and the duration. I understand the NDAEB reserves the right to determine whether my request for special testing accommodations will be granted and that I will be advised in writing of the decision. *By signing this form, I understand that if a Recorder is provided as a result of my request for special accommodation, the Recorder, the NDAEB and its agents “assume no liability” and “are not responsible” for ensuring the accuracy of the Written Examination and/or Clinical Practice Evaluation (CPE) results, and that it is my responsibility to ensure that my answers are recorded on the answer sheet according to my instructions. Signature:________________________________________Date ________________ (yyyy-mm-dd)

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