Fillable Commonwealth of Massachusetts Board of Bar Examiners - Form 2 - Learning Disability Verification

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Commonwealth of Massachusetts Board of Bar Examiners - Form 2 - Learning Disability Verification

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  • 8 check-boxes
  • 55 other fields

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FORM 2: LEARNING DISABILITY VERIFICATION
NOTICE TO QUALIFIED PROFESSIONAL:
The above-named person is requesting accommodations on the Massachusetts Bar Examination.
All such requests must be supported by a comprehensive written evaluation report from the
qualified professional who conducted an individualized assessment of the applicant and is
recommending accommodations on the bar examination on the basis of a learning disability. The
Board of Bar Examiners also requires the qualified professional to complete this form. If any of
the information requested in this form is fully addressed in the comprehensive evaluation
report, you may respond by citing the specific page and paragraph where the answer can
be found. Please attach a copy of the comprehensive evaluation report and all records and test
results on which you relied in making the diagnosis and recommending accommodations for the
Massachusetts Bar Examination. We appreciate your assistance.
The Board of Bar Examiners may forward this information to one or more qualified
professionals for an independent review of the applicant’s request.
Print or type your responses to the items below. Return this completed form, the
comprehensive evaluation report, and relevant records and test results to the applicant for
submission to the Board of Bar Examiners.
NOTICE TO APPLICANT: This section of this form is to be completed by you. The
remainder of the form is to be completed by the qualified professional who is recommending
accommodations on the Massachusetts Bar E
xamination for you on the basis of a learning
disability. Please read, complete, and sign below before submitting this form to the qualified
professional for completion of the remainder of this form.
Applicant’s full name:
Date(s) of evaluation/treatment:
Applicant’s date of birth:
I give permission to the qualified professional completing this form to release the
information requested on the form, and I request the release of any additional
information regarding my disability or accommodations previously granted that may
be requested by the Massachusetts Board of Bar Examiners or consultant(s) of the
Massachusetts Board of Bar Examiners.
Signature of a
pplicant: _________________
________
Date:____________________
MASSACHUSETTS BOARD OF BAR EXAMINERS
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signature
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Form 2-Page
2
Rev.09/19
I. EVALUATOR/TREATING PROFESSIONAL INFORMATION
Name of professional completing this form:
Address:
Telephone: _____________________________ Fax:
E-mail:
Occupation and specialty: ________________________________________________________
License number/Certification/State:
Describe your qualifications and experience to diagnose and/or verify the applicant’s condition
or impairment and to recommend accommodations.
II. DIAGNOSIS AND CURRENT FUNCTIONAL LIMITATIONS
1. Provide the date the applicant was first diagnosed with a learning disability.
2. Did you make the initial diagnosis? Yes No
If no, provide the name of the professional who made the initial diagnosis and when it was
made, if known. Attach copies of any prior evaluation reports, test results, or other
available records related to the initial diagnosis that you reviewed.
3. When did you first meet with the applicant?
4. Provide the date of your last complete evaluation of the applicant. _____________________
Form 2-Page
3
Rev. 09/19
5. Provide a concise description of your diagnosis. Please include the specific DSM-IV-TR (or
most current version) diagnosis:
6. Describe the applicant’s current level of functioning and the impact of any functional
limitations on the applicant’s major life activities.
7. Was the applicant’s motivation level, interview behavior, and/or test-taking behavior
adequate to yield reliable diagnostic information/test results? Yes No
Describe how this determination was made, including whether any symptom validity tests
were administered. If such tests were not administered, please state why they were not.
ATTACH A COMPREHENSIVE EVALUATION REPORT. An applicant’s specific
learning disabilities must have been identified by an appropriate psychoeducational assessment
process that is well documented in the form of a comprehensive diagnostic report. The provision
of reasonable accommodations is based on assessment of the current impact of the disability on
the specific testing activity. Although a learning disability normally is lifelong, the severity and
manifestations can change. The Board of Bar Examiners generally requires documentation from
an evaluation conducted within the last five years to establish the current impact of the disability.
Attach to this form a copy of the comprehensive evaluation report and all records and test
results on which you relied in making the diagnosis and recommending accommodations
for the Massachusetts Bar Examination. The evaluation report should include the following:
A. an account of a thorough diagnostic interview that summarizes relevant components of the
individual’s developmental, medical, family, social, and educational history;
B. clear, objective evidence of a substantial limitation to learning or performance provided
through assessment in the areas of cognitive aptitude, achievement, and information
processing abilities (results must be obtained on standardized test(s) appropriate to the
general adult population and be reported in age-based standard scores and percentiles);
Form 2-Page
4
Rev. 09/19
C. interpretation of the diagnostic profile that integrates assessment data, background history,
and observations made during the evaluation process, as well as the inclusion or ruling out of
possible coexisting conditions (such as previously diagnosed psychological issues or English
as a second language) affecting the applicant’s performance;
D. a specific diagnostic statement, including the DSM-5 diagnostic code; and
E. a rationale for each recommended accommodation based on diagnostic information presented
(background history, test scores, documented observations, etc.).
III. FORMAL TESTING
It is important that the tests used in the evaluation are reliable, valid, and age-appropriate, and
that the most recent edition of each diagnostic measure is used. Scores should be reported as age-
based standard scores and percentiles. The following lists of tests are provided as a guide to
assessment instruments appropriate for the adult population. The lists are not intended to be all-
inclusive and will vary with the needs of the individual being evaluated.
1. Aptitude/Cognitive Ability
- Wechsler Adult Intelligence Scale IV (WAIS IV) (including IQ, index, and scaled scores)
- Woodcock-Johnson IV (WJ IV): Tests of Cognitive Ability
- Stanford-Binet Intelligence Scale: Fifth Edition (SB5)
Please note: The Slossen Intelligence Test and the Kaufman Brief Intelligence Test are
primarily screening instruments and should not be considered comprehensive measures of
aptitude
/cognitive ability.
2. Achievement
- Woodcock-Johnson IV (WJ IV): Tests of Achievement
- Wechsler Individual Achievement Test (WIAT
III)
- Scholastic Abilities Test for Adults (SATA)
Please note: The Wide Range Achievement Test: Fourth
Edition (WRAT-4), the Peabody
I
ndi
vidual Achievement Test (PIAT, PIAT-R), and the Nelson Denny Reading Test are not
comprehensive measures of academic achievement and should not be used as sole measures
in this area.
3. Information Processing (if applicable)
- Wechsler Memory Scale IV (WMS-IV)
- Swanson Cognitive Process Test (S-CPT)
Form 2-Page
5
Rev.09/19
- Information from subtest, index, and/or cluster scores on the WAIS IV (Working
Memory, Perceptual Organization, Processing Speed) and/or the Woodcock-Johnson
I
V (WJ IV): Tests of Cognitive Ability (Visual Processing, Short Term Memory,
Long Term Memory, Processing Speed) and/or The Detroit Tests of Learning
Aptitude-Adult (DTLA-A), as well as other neuropsychological instruments that
measure rapid automatized naming and/or phonological processing.
IV. ACCOMMODATIONS RECOMMENDED FOR THE
MASSACHUSETTS BAR
EXAMINATION (CHECK ALL THAT APPLY)
Th
e Massachusetts Bar
Examination is a timed written examination administered in three-
hour sessions from 9:30 a.m. to 12:30 p.m. and from 2:00 p.m. to 5:00 p.m. on
Tuesday and Wednesday as scheduled twice each year. There is a lunch b
reak each day.
The first day consists of
two performance tests (MPT) in the morning and six essay
(MEE) questions in the afternoon. The performance and essay questions are designed to
assess, among other things, the applicant’s ability to communicate his/her analysis
effectively in writing. Applicants may use their personal laptop computers to type
their answers, or they may handwrite their answers.
The second day consists of 200 multiple-choice questions (MBE), with 100 questions
administered in the morning session and 100 questions in the afternoon session.
Applicants record their answers by darkening circles on an answer sheet that is scanned by
a computer to grade the examination.
Applicants are assigned seats, two per six-foot table, in a room set for 200 to 1500 applicants.
They are not allowed to bring food, beverages other than water, or other items into the testing
room unless approved as accommodations. The examination is administered in a quiet
environment, and applicants are allowed to use small foam earplugs. They may leave the room
only to use the restroom or drinking fountain, within the time allotted for the test session.
Taking into consideration this description of the examination and the functional
limitations currently experienced by the applicant, what test accommodation (or
accommodations, if more than one would be appropriate) do you recommend?
Test question formats:
Braille
Audio CD
Microsoft Word document on data CD
for use with screen-reading software (for
MPT and MEE)
Large print/18-point font
Large Print / 24 point font
Form 2-Page
6
Rev. 09/19
Assistance:
Reader
Typist/Transcriber for written portion (MPT/MEE)
Scribe for MBE
Explain your recommendation(s) below.
Extra testing time. Indicate below how much
extra testing time is recommended. Note: For
applicants awarded 50% or 100% additional testing time for all sessions of the bar exam, the order
of the UBE is MEE on Tuesday, MBE on Wednesday and Thursday, and the MEE on Friday.
Test Portion
Standard Time
per session
E
xtra Time Recommended (i.e. time and
a
half, one extra hour, 30 extra minutes)
MBE
Multiple
-Choice
3 hours AM
MPT
Performance Test
3 hours PM
Explain why extra testing time is necessary and describe how you arrived at the specific amount
of extra time recommended. If either the amount of time or your rationale is different for
diff
erent portions of the examination, please explain. If relevant, address why extra breaks or
longer breaks are insufficient to accommodate the applicant’s functional limitations.
30
60
Double
3 hours AM
3 hours PM
MEE
Essay
30
60
Double
30
60
Double
Off the Clock
90
Off the Clock
90
Off the Clock
90
Form 2-Page
7
Rev.09/19
Other arrangements (e.g., lamp, lumbar support, magnifying items, medication, etc.).
Describe the recommended arrangements and explain why each is necessary.
V. PROFESSIONAL’S SIGNATURE
I have attached a copy of the comprehensive evaluation report and all records, test results,
or reports upon which I relied in making the diagnosis and completing this form.
I certify that the information on this form is true and correct based upon the information in my
records.
_____________________________________________
Signature of person completing this form
_____________________________________________
Title
__________________________
Date signed
__________________________
Daytime telephone number
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Commonwealth of Massachusetts Board of Bar Examiners - Form 2 - Learning Disability Verification

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Completed 20 May 2020

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