Accommodation Request for Examination
In compliance with Title 2 under the federal Americans
with Disabilities Act (ADA), and California Fair Employment
and Housing Act (Government Code §12900-12996),
the Contractors State License Board (CSLB) provides
applicants with disabilities with the reasonable
accommodations that they need. It is the applicant’s
responsibility to notify CSLB of alternative arrangements
needed to enable them to take the licensure examinations.
CSLB is not required to provide accommodations if we
are unaware of the needs of examination candidates.
The information requested below and any documentation
regarding your disability will be strictly confidential, and
will not be shared with any outside source without your
express written permission unless required to be disclosed
pursuant to subpoena or under state or federal law.
CSLB administers examinations in Test Centers
throughout the state. All locations are wheelchair
accessible. Examinations are taken on a touchscreen
computer at an individual testing station (desk).
Candidates select their answers by touching the screen.
If you have any questions or need assistance determining
whether you may require accommodations, please call
1-800-321-2752 (CSLB).
1 Personal Information
FIRST NAME MIDDLE NAME LAST NAME
STREET ADDRESS
CITY STAT E ZIP CODE PHONE NUMBER
( )
DISABILITY
2 Requirements for Accommodation Requests
If your disability is observable and your request does not involve modifying examination procedures, but concerns
wheelchair space or equipment needs, it is not necessary to obtain professional verification; otherwise, you are
required to submit documentation from a medical authority or learning institution.
Verification MUST be submitted to CSLB on the letterhead stationery of the authority or specialist and
include the following:
(A) Description of the disability and limitations
related to testing
(B) Recommended accommodation/modification
(C) Name, title and telephone number of the
doctor or specialist
(D) Signature of the doctor or specialist
(E) Professional license or certification number
of the doctor or specialist
If you have previously been granted special testing accommodations by an organization that required
documentation to verify your disability, CSLB may accept a copy of the verification, provided you submit the
name, address and telephone number of the medical authority, specialist or learning institution that prepared
the documentation.
BOTH SIDES OF THIS FORM MUST BE COMPLETED
