Fillable Commonwealth of Massachusetts Board of Bar Examiners - Form 6 - Physical Disability Verification

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Commonwealth of Massachusetts Board of Bar Examiners - Form 6 - Physical Disability Verification

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The Commonwealth of Massachusetts Board of Bar Examiners - Form 6 - Physical Disability Verification form is 6 pages long and contains:

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  • 10 check-boxes
  • 80 other fields

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U.S.A. forms for Commonwealth of Massachusetts

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FORM 6: PHYSICAL 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 evaluation report from the qualified
professional who conducted an individualized assessment of the applicant and is recommending
accommodations on the Massachusetts Bar Examination on the basis of a physical 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 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 provision of reasonable accommodations is based on assessment of the current impact of the
disability on the specific testing activity. The Board of Bar Examiners generally requires
documentation from an evaluation conducted within the past year because of the changing
manifestations of many physical disabilities. Older evaluation reports may suffice if
supplemented by an update of the diagnosis, current level of functioning, and a rationale for each
recommended accommodation or an explanation of why the report continues to be relevant in its
entirety.
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
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 test
accommodations on the Massachusetts Bar Examination for you on the basis of a physical
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 applicant: ______________________ Date: _________________
MASSACHUSETTS BOARD OF BAR EXAMINERS
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Form 6-Page 2
Rev. 09/19
to the items below. Return this completed form, the comprehensive evaluation report, and
relevant records to the applicant for submission to the Board.
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 RESULTING FUNCTIONAL LIMITATIONS
1. What is the specific diagnosis (including diagnosis code) for which the applicant requests test
accommodations?
2. Describe the nature of the physical disability. Include a history of presenting symptoms, date
of onset, and description of the duration and severity of the disability.
Form 6-Page 3
Rev. 09/19
3. When did you first meet with the applicant?
4. When was the applicant’s physical disability first diagnosed?
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 records
related to the initial diagnosis that you reviewed.
5. Provide the date of your last complete evaluation of the applicant.
6. Is this a permanent condition/impairment? Yes No
If no, when is it likely to abate?
7. Does the severity of the condition/impairment fluctuate? Yes No
If yes, describe the settings and/or circumstances affecting severity that are relevant to taking
the bar examination.
8. Describe the applicant’s current functional limitations and explain how the limitations restrict
the condition, manner, or duration under which the applicant can take the bar examination.
9. Briefly describe any treatment, including any prescribed medications, and the effectiveness
of treatment in reducing or ameliorating the applicant’s functional limitations.
Form 6-Page 4
Rev. 09/19
III. ACCOMMODATIONS RECOMMENDED FOR THE MASSACHUSETTS BAR
E
XAMINATION (CHECK ALL THAT APPLY)
The 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 break each day.
The first day consists of two performance tests (MPT) in the morning session and six essay
questions (MEE) in the afternoon session. 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 or eight-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, provided by the Board of
Bar Examiners. 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 Version
Microsoft Word document on data CD
for use with screen-
reading software (for essay sessions)
Large print/18-point font
Large print/24-point font
Form 6-Page 5
R
ev. 09/19
Assistance:
Reader
Typist/Transcriber for essay portion
Scribe for MBE
Explain your recommendation(s). __________________________________________________
Extra testing time. Indicate below how much extra testing time is recommended:
Test Portion
Standard Time
Extra
Time Recommended
(30
extra minutes,
one hour, time and a half
)
MBE/Multiple-Choice
3 hours AM
3 hours PM
MEE / Essay
3 hour
s AM
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
different portions of the examination, please explain. If relevant, address why extra breaks or
longer breaks are insufficient to accommodate the applicant’s functional limitations.
Other arrangements (e.g., lamp, lumbar support, magnifying items, medication, etc.).
Describe the recommended arrangements and explain why each is necessary.
MPT / Performance Test
30 60 90
Off the Clock Double
30 60 90
Off the Clock Double
30 60 90
Off the Clock Double
Form 6-Page 6
Rev. 09/19
IV. 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 Date signed
_____________________________________________ __________________________
Title Daytime telephone number
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Commonwealth of Massachusetts Board of Bar Examiners - Form 6 - Physical Disability Verification

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Completed 19 May 2020

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