Fillable Commonwealth of Massachusetts Board of Bar Examiners - Form 1 - Application for Nonstandard Test Accommodations

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Commonwealth of Massachusetts Board of Bar Examiners - Form 1 - Application for Nonstandard Test Accommodations

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The Commonwealth of Massachusetts Board of Bar Examiners - Form 1 - Application for Nonstandard Test Accommodations form is 16 pages long and contains:

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  • 62 check-boxes
  • 148 other fields

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File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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Form 1-Page
1 Rev. 9/19
FORM 1: APPLICATION FOR NONSTANDARD TEST
ACCOMMODATIONS
NOTICE TO APPLICANT: This form is part of your request for test accommodations on the
bar examination. This form and all other applicable forms and required documentation must be
filed on or before the deadline of your application for admission. If additional space is needed to
respond to any item, please attach a separate page.
Full name:
Date of birth:
NCBE #:
Yes
No
Yes
No
Have you previously taken the Massachusetts Bar
Ex
amination
?
If yes, did you receive nonstandard test accommodations?
Are you electing to participate in the Board’s laptop program for the written portions of the exam? Please
note spelling and grammar are not graded on the
examination, and spell check and grammar check will
Yes
No
Yes
No
not be available for the exam.
Are you receiving or have you applied for S
ocial Security Disability
Benefits? (Provide supporting documentation.)
I. YOUR DISABILITY STATUS
1. Check the disability or disabilitie
s for which you are requesting accommodations.
Visual impairment
Hearing impairment
Psychological disability
Spcific Learning disability
AD/HD
Physical disability
Other (describe)
Please identify your specific Disability diagnosis ______________________________________
Address:______________________________________________________________________
Phone number: ________________________ E-Mail address:_____________________________________
Law School (s)________________________ Dates attended:___________________________
Date of examination you intend to take:______________
ALL applicants seeking Non-Standard Test Accommodations will be seated at the Boston location.
Applicants who
submit this application will be seated in Boston regardless of the outcome of this request.
Please initial your agreement / understanding of this statement. _________________
Form 1-Pa ge 2
Rev. 9/19
2. List your age when first diagnosed. ______________
3. Are you currently being treated?
Yes No
If yes, provide the name, qualifications, and telephone number of your treating
professional(s).
4. List any treatment and/or medication currently prescribed for the disability or disabilities
identified above, or list “none.”
5. Is the treatment or medication effective in controlling symptoms? Yes No N/A
If no, describe remaining symptoms and any side effects.
6. Personal Statement: Attach a personal narrative (include your name and your signature) describing
when you first became impaired by your disability, when you were first diagnosed, how your
disability impacts your daily life activities including your educational and testing functions, and how
your disability affects your ability to take the bar examination under standard conditions.
II. HISTORY OF ACCOMMODATIONS
For questions 1 through 7 below, please follow these instructions:
If you were granted accommodations, check “Yes.” List the condition or diagnosis for which
accommodations were granted, the specific accommodations granted, the educational institution
or testing agency that granted the accommodations, and the time frame.
If you did not request accommodations, check “Not requested.” Explain why you did not request
accommodations.
If you were denied accommodations, in whole or in part, check “Denied.” List the month and
year the request was made, the condition or diagnosis for which accommodations were
requested, the accommodations requested, the educational institution or testing agency, and the
Form 1-Pa ge 3
Rev. 9/19
reason given by the entity for the denial. Note: if your request for accommodations was
granted in part and denied in part, you should check both “Yes” and “Denied.”
1. Did you receive accommodations for the bar examination taken in another jurisdiction?
Yes Not requested Denied N/A
2. Did you receive accommodations for the Multistate Professional Responsibility Examination
(MPRE)?
Yes Not requested Denied N/A
3. Did you receive accommodations in law school?
Yes Not requested Denied N/A
4. Did you receive accommodations in college (undergraduate or graduate studies)?
Yes Not requested Denied N/A
5. Did you receive accommodations for any of the following standardized tests:
LSAT Yes Not requested Denied N/A
MCAT Yes Not requested Denied N/A
GRE Yes Not requested Denied N/A
Form 1-Pa ge 4
Rev. 9/19
GMAT Yes Not requested Denied N/A
SAT Yes Not requested Denied N/A
ACT Yes Not requested Denied N/A
6. Did you receive accommodations or disabled-student services in high school, including but
not limited to accommodations or services provided as a result of an Individualized
Education Plan (IEP) or a 504 Plan?
Yes Not requested Denied N/A
7. Did you receive accommodations or disabled-student services in elementary or middle
school, including but not limited to accommodations or services provided as a result of an
IEP or a 504 Plan?
Yes Not requested Denied N/A
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
III. ACCOMMODATIONS REQUESTED FOR THE MASSACHUSETTS BAR
EXAMINATION (CHECK ALL THAT APPLY)
Test question formats:
Braille
Audio CD
Microsoft Word document on CD for use with screen-reading software
(for essay sessions)
Large print/18-point font
Large print/24-point font
Assistance:
Reader
Scribe for MBE
Typist/Transcriber for written portion (MPT/MEE)
Extra testing time. Indicate below how much extra testing time is requested Note: For
applicants awarded 50% or 100% additional time for all sessions, the exam will be in
Boston only on Tuesday, Wednesday, Thursday and Friday.
Test Portion
Standard Time
Extra Time Requested
(
ext
r
a
minutes
per
3
hour
session
)
MPT /Performance Test
3 hours AM
MEE/ Essay
3 hours PM
MBE/Multiple-Choice
3 hours AM
3 hours PM
Other arrangements. Bring your own aids (e.g., lamp, lumbar support, magnifying
items, medication, etc.). Describe the arrangements below.
For each accommodation you are requesting, explain why the accommodation is
necessary and how it alleviates the impact of your disability or disabilities in the
context of taking the bar examination.
30
60
Off the Clock
90
Double
30
60
Off the Clock
90
Double
30
60
Off the Clock
90
Double
Form 1-Page 5
Rev 9/19
Form 1-Pa ge 6
Rev. 9/19
IV. SUPPORTING DOCUMENTATION
Requests for test accommodations must be supported
by the following documentation from
third parties, which you must provide with your completed Form 1: Application for
Nonstandard Test Accommodations. Review the General Instructions for Requesting Test
Accommodations for a detailed explanation of the supporting documentation you should
submit.
Medical Documentation
Submit supporting medical documentation from a qualified professional who conducted
an individualized assessment and who gave the diagnosis which forms the basis for the request
for test accommodations. If you are requesting accommodations based upon more than
one disability, you should supply medical documentation to support each disability.
Verification of Accommodations History
Provide verifying documentation of your accommodations history, if any. Submit a Form
7: Certification of Accommodations History completed by each educational institution or
testing agency (hereinafter “entity”) from which you requested accommodations in the past,
whether granted or denied. Alternatively, you may provide other proof of your
accommodations history, such as a copy of the letter(s) you received from the entity
notifying you of the specific accommodations granted or denied. The proof should identify
the time frame (e.g., third year of law school) and the nature of the disability (e.g., AD/HD)
for which any accommodations were granted or denied. If you received accommodations as a
result of an Individualized Education Plan (IEP) or a 504 Plan, please provide copies of all
IEPs or 504 Plans.
Academic Transcripts
Attach copies of your undergraduate and law school transcripts and your LSAC Candidate Item
Response Report. Transcripts or report cards from elementary, middle, junior high, and high
school, while not required, are helpful and may be requested by the Board in some cases.
Standardized Test Scores
Attach copies of your standardized test scores including but not limited to score reports, SAT,
LSAT, MPRE, GMAT, GRE.
Form 1-Pa ge 7
Rev. 9/19
V. APPLICANT CHECKLIST
Review this checklist carefully and checkmark the appropriate lines to indicate the documents
you are submitting to request accommodations for the Massachusetts Bar Examination. Submit
this completed checklist with your request. Review carefully the General Instructions for
Requesting Test Accommodations, particularly the section “Steps for Submitting a
Complete Request.”
1. The applicable disability verification form with comprehensive evaluation report and/or
relevant records attached
____ Form 2: Learning Disability Verification
____ Form 3: Attention Deficit/Hyperactivity Disorder Verification
____ Form 4: Psychological Disability Verification
____ Form 5: Visual Disability Verification
____ Form 6: Physical Disability Verification
2. A Form 7: Certification of Accommodations History completed by each entity from
which you previously requested accommodations and/or a copy of notification letters
____ Not applicable (if you have never requested accommodations before)
____ Bar examining agency in another jurisdiction
____ MPRE
____ Law school
____ Undergraduate or graduate studies
____ Standardized tests (LSAT, MCAT, GRE, GMAT, SAT, ACT)
____ Individualized Education Plan (IEP) or 504 Plan
____ High school (other than IEP or 504 Plan)
____ Elementary or middle school (other than IEP or 504 Plan)
Form 1-Pa ge 8
Rev. 9/19
3. Academic Transcripts (if applicable)
____ Not applicable (if you do not have a learning disability or AD/HD)
____ Law school transcript(s)
____ LSAC Candidate Item Response Report
____ Undergraduate transcripts(s)
____ [Optional] Elementary, middle, and high school transcripts
4. Application form
____ Completed and signed Form 1: Application for Nonstandard Test Accommodations
____ Personal Statement
____All forms submitted in duplicate
____This completed checklist
I have completed and attached all the required forms and supporting documentation.
___________________________________________ __________________
Applicant signature Date signed
If you are unable to sign this form, please have someone sign and date in your presence.
___________________________________________
Signature o
f individual signing on behalf of applicant
___________________
Date signed
click to sign
signature
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signature
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Form 1-Pa ge 9
Rev. 9/19
VI. CERTIFICATION THAT INFORMATION SUPPLIED IS TRUE AND COMPLETE
Initial
The information I have provided in support of my request for test accommodations
is true, accurate and complete.
Initial
I understand that if the Board of Bar Examiners determines that I, or a third party
on my behalf, submitted as part of this request any information or documentation
that is false, inaccurate, or intentionally misleading, the Board of Bar Examiners
reserves the right to treat such conduct as a character and fitness issue and I may
jeopardize my examination results, admission to the bar of the Commonwealth of
Massachusetts, my
subsequent good standing as a member of the bar, and that I may be
subjected to such penalties as provided by law.
Initial
Initial
I understand that all necessary documentation and information must be provided to
the Board of Bar Examiners with my
Application for Nonstandard Test
Accommodations by the deadline and that my request for test accommodations will
not be considered if the deadline is missed.
I understand that I must submit an original and a copy of my Application for
Nonstandard Test Accommodations and all other applicable forms.
________________________________________ ______________________
Applicant signature Date signed
If you are unable to sign this form, please have someone sign and date in your presence.
___________________________________________ ______________________
Signature of individual signing on behalf of applicant Date signed
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signature
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signature
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Form 1-Page 10
Rev. 9/19
VII. APPLICATION FOR NONSTANDARD TEST ACCOMMODATIONS
AUTHORIZATION AND RELEASE
I, _____________________________, authorize the Massachusetts Board of Bar Examiners to
(Name)
provide at the Board’s discretion, a copy of any and all documents which I submit in connection
with this Application for Nonstandard Test Accommodations to such persons and/or consultants as
the Board may deem necessary to adequately evaluate my request for testing accommodations. I
authorize such disclosure.
If further information regarding the documentation that I have provided is needed, I authorize
the Board of Bar Examiners to contact the professional(s) who diagnosed and/or treated my
disability. I further authorize such professionals to communicate with the Board in this regard to
provide such clarification and/or further information and documentation as the Board requires.
I authorize the Board to contact those entities which have provided me test accommodations
or with whom I have a concurrent application for test accommodations pending for
the purposes of ascertaining what accommodations have been or will be granted or denied.
I further authorize such entities to communicate with the Board in this regard to provide
such clarification and/or further information and documentation as the Board requires.
I hereby release, discharge and exonerate the Board and/or its designee(s) and/or any persons to
whom information may be provided pursuant to this Authorization and Release from any and all
liability of every nature and kind arising out of the furnishing or receipt of such information made
by or on behalf of the Board.
__________________________________________ _____________________
Applicant signature Date signed
If you are unable to sign this form, please have someone sign and date in your presence.
___________________________________________ ______________________
Signature of individual signing on behalf of applicant Date signed
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Commonwealth of Massachusetts Board of Bar Examiners - Form 1 - Application for Nonstandard Test Accommodations

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Completed 19 May 2020

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