Fillable District of Columbia Court of Appeals Request for (Superior Court of DC)

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District of Columbia Court of Appeals Request for (Superior Court of DC)

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Request for District of Columbia Bar Examination
Testing Accommodations
District of Columbia Court of Appeals
Committee on Admissions
430 E Street N.W. Room 123
Washington, D.C., 20001
Phone: (202) 879-2710
Email: dcaccommodations@d
cappeals.gov
APPLICANT REQUEST FORM
GENERAL INFORMATION:
1. Bar Examination Test Date: ____________________ (month/year)
2. Full Name ____________________(first/middle/last):
3. NCBE Number: N ______________________
4. Date of Birth: __________________________
5. Daytime Telephone: ______________________
6. Email: _________________________________
7. Mailing Address:
City: _____________________________
State: _____________________________
Zip: ______________________________
Country: __________________________
District of Columbia Bar Exam History:
1. Have you previously taken the District of Columbia Bar Exam?
Yes No
If yes, list all test dates (month/year). _______________________________________________
2. Have you previously requested test accommodations for the District of Columbia Bar Exam?
Yes No
If yes, list all test dates (month/year) for which you requested accommodations and state whether your request
was granted.
INFORMATION ABOUT YOUR DISABILITY
1. Mark an “X” beside your disability or disabilities and list the specific diagnosis:
_____ ADHD:
_____ Learning disorder:
_____ Psychological:
_____ Chronic health condition:
_____ Physical:
_____ Visual:
_____ Hearing:
_____ Other:
3. List the month and year when each disability was first diagnosed.
4. Describe your current functional limitations and how those limitations will affect your ability to take the
bar examination.
5. Describe all treatment, medication, devices, auxiliary aids, or strategies you ordinarily use to ameliorate
the functional impact of your disability or disabilities and the effectiveness thereof, or list “none.”
ACCOMMODATIONS REQUESTED
The D.C. Bar Exam is a two-day, twelve-hour hour timed examination that consists of three different types of
tests. The Multistate Essay Examination (MEE) and the Multistate Performance Test (MPT), and the
Multistate Bar Examination (MBE). The February exam will be administered remotely by computer.
Applicants will provide their own computers, internet access, and will take the exam in a location of their own
choosing.
Please see the General Information Regarding Accommodations for additional information regarding the
schedule for the exam.
Please see exam instructions for additional information about the exam.
Prescription medication, glucose monitors, ergonomic devices, standing desks, and other medical devices are
permitted at the exam. Additionally, equipment for non-ADA conditions (e.g. breast pumps) are permitted.
Mark an “X” below to indicate the accommodations you are requesting.
1. EXTENDED TESTING TIME (CHECK ONE):
_____ 25% extended testing time (extra 45 minutes)
_____ 50% extended testing time (extra 90 minutes)
_____ 100% extended testing time (extra 180 minutes)
_____ Other amount (specify other amount):
2. SUPERVISED BREAKS (NOT COUNTED IN TESTING TIME):
_____ Breaks (describe duration and frequency):
3. TEST FORMAT/ACCESSIBILITY:
_____ Large-print test book and answer sheet (select font size: 18-point font; or 24-point font)
_____ Braille Audio CD
_____ Auxiliary aid (describe auxiliary aid):
_____ Reader
_____ Record answers in test booklet (multiple choice only)
_____ Scribe to complete answer sheet
_____ Wheelchair accessible table (specify height):
4. OTHER ACCOMMODATION NOT LISTED ABOVE (DESCRIBE):
YOUR ACCOMMODATIONS HISTORY
For questions 1 through 5 below, please follow these instructions: If you were granted accommodations, check
“Granted” and briefly describe the accommodations provided. (Note: You must provide verifying
documentation of all accommodations.) If you did not request accommodations, check “Not Requested” and
explain why you did not request accommodations. If you were denied accommodations, check “Denied” and list
the reason(s) given by the entity for the denial. If you did not attend the type of school listed or did not take the
exam listed, check “N/A.”
1. Were you granted accommodations for the bar examination?
_____ Granted
_____ Not Requested
_____ Denied
_____ N/A
Explanation:
2. Were you granted accommodations in law school?
_____ Granted
_____ Not Requested
_____ Denied
_____ N/A
Explanation:
3. Were you granted accommodations in college (undergraduate or graduate studies)?
_____ Granted
_____ Not Requested
_____ Denied
_____ N/A
Explanation:
4. Were you granted accommodations or disabled-student services in elementary or secondary school,
including but not limited to accommodations or services provided under an Individualized Education
Plan (IEP) or a 504 Plan?
_____ Granted
_____ Not
_____ Requested
_____ Denied
_____ N/A
Explanation:
5. Were you granted accommodations for any of the following standardized tests:
_____ LSAT:
_____ Granted
_____ Not Requested
_____ Denied
_____ N/A
MPRE:
_____ Granted
_____ Not Requested
_____ Denied
_____ N/A
GRE:
_____ Granted
_____ Not Requested
_____ Denied
_____ N/A
GMAT:
_____ Granted
_____ Not Requested
_____ Denied
_____ N/A
SAT:
_____ Granted
_____ Not Requested
_____ Denied
_____ N/A
ACT:
_____ Granted
_____ Not Requested
_____ Denied
_____ N/A
Explanation:
6. Do you have any accommodation requests pending with other entities (e.g., the bar exam)?
_____ Yes
_____ No
If yes, list each entity, the accommodations you requested, and the date that you submitted your request.
ACADEMIC HISTORY
1. List your postsecondary educational history, including all colleges, universities, law schools, and other
graduate or professional schools you have attended. State the dates of attendance and degree(s) earned.
OPTIONAL PERSONAL STATEMENT
If there is anything else you would like the Committee to know about your disability and need for
accommodations, you may attach a personal narrative. Include your name and NCBE number on every page.
CERTIFICATION AND AUTHORIZATION
The information I have provided in support of my request for test accommodations is true and complete. I
understand that if the Committee 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 Committee
reserves the right to cancel my bar exam score. I authorize the Committee to contact all educational institutions
and/or testing agencies that have provided me with test accommodations and/or are considering a pending
application for test accommodations to clarify the accommodation(s) that have been or will be granted or
denied.
I understand that both my request for test accommodations and all supporting documentation may be submitted
for evaluation to one or more qualified professionals retained by the Committee, and I authorize such
disclosure. I understand that all necessary documentation and information must be received by the Office of
Admissions by the deadline in order for my request for test accommodations to be considered.
Signature: ____________________________________________
Date signed: ____________________________________
If you are unable to sign this form, p
lease have someone sign and date it in your presence:
_________________________________
Individual’s signature:
Electronic Signature is acceptable
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District of Columbia Court of Appeals Request for (Superior Court of DC)

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Completed 25 March 2021

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