Services for Students with Disabilities
Consent Form for Accommodations Request
Student Information
Student Name: ______________________________________
School: _____________________________________________
Student Date of Birth: _________________________________
Student and Parent/Guardian Signature
I wish to apply for testing accommodation(s) on College Board tests (SAT, SAT Subject Tests, PSAT 10,
PSAT/NMSQT, and/or Advanced Placement Exams) due to disability. I authorize my school: to release
to the College Board copies of my records that document the existence of my disability and need for
testing accommodations; to release any other information in the school's custody that the College Board
requests for the purpose of determining my eligibility for testing accommodations on College Board
tests; and to discuss my disability and accommodation needs with the College Board. I also grant the
College Board permission to receive and review my records, and to discuss my disability and needs with
school personnel and other professionals.
Student Signature: _________________________________________________ Date: _____________
Parent/Guardian Signature: __________________________________________ Date: _____________
(Parent/guardian signature is required if Student is under 18.)
Instructions to the School
This form should be used when a request for accommodation(s) is submitted electronically (via SSD
Online). The form should be maintained by the school with the student’s records. It does not need to be
sent to the College Board. You will be asked to verify that a signed Consent Form is on file at the school
prior to submitting a request for accommodations.
rev/Nov2017
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome