Request for Special Testing Accommodations

Request For Special Testing Accommodations 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 will not be granted. I__________________________________________________________ request the following special sitting accommodations for (print your full name) the NDAEB Written Examination or Clinical Practice Evaluation (CPE) scheduled for: ________________________________. (yyyy-mm-dd) Select the request special testing accommodations from the list below:  Separate room  Extra time (time and one half = 6 hours)  Exam reader  Text-to-speech software  Recorder*  Alternate date for religious reasons  Prayer time(s)  Other (please specify)________________________________________________________________________________ Note: Text-to-speech software (e.g. Kurzweil) is site specific and cannot be guaranteed.  I have enclosed the following documents to support my request:  Report explaining my learning disability and recommended accommodation(s) completed in the previous 5 years signed by a psychologist / learning disabilities specialist.  Letter signed by my physician written in the past year explaining the nature of my disability (other than learning disability).  Letter signed by a religious leader written in the past year confirming the need for an alternate sitting date for religious reasons.  Letter stating the time(s) and duration required for prayer.  I understand that 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 according to my instructions. Signature: Date: (yyyy-mm-dd)

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