SERVICES FOR STUDENTS WITH DISABILITIES
Consent Form for Accommodations Request
Student Information
Student Name:
School:
Student Date of Birth:
I wish to apply for testing accommodation(s) on College Board tests (SAT
®
, PSAT
™
10,
PSAT/NMSQT
®
, and/or Advanced Placement
®
Exams) due to disability. I authorize my
school: to release to 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 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 College Board. I also grant 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.)
School Instructions
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 College Board. You will be asked to verify that a signed consent form is on le at the
school prior to submitting a request for accommodations.
© 2021 College Board. 2122-X-522c
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