If yes, list each entity, the accommodations you requested, and the date that you submitted your request.
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
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.
Date signed: ____________________________________
If you are unable to sign this form, p
lease have someone sign and date it in your presence:
Electronic Signature is acceptable