Office of Court Management
Two Center Plaza, Room 540
Boston, MA 02108
MASSACHUSETTS TRIAL COURT
Request for a Reasonable Accommodation for the Exam
Exam Title:_______________________________________________________________________________
Registrant Name:__________________________________________________________________________
Home Address:____________________________________________________________________________
Email Address:_________________________________ Daytime Telephone Number__________________
Please note: This form and the required supporting documentation must be either emailed to
exams@jud.state.ma.us or faxed to (617)742-0968 on or before April 4, 2019.
I am requesting the following reasonable accommodation for the exam.
I am submitting the required letter of support from a qualified professional detailing what type of
accommodation I require at the examination site. This form and letter must be scanned and emailed to
exams@jud.state.ma.us or faxed to (617)742-0968 by April 4, 2019. Without receipt of such documentation
by April 4, 2019, we cannot guarantee that we will be able to grant your accommodation. This information is
requested only to provide a reasonable accommodation for examinations, and will not be used for any other
purposes.
I understand that it is my responsibility to ensure that this Form and the required supporting documentation are
provided as outlined above. I understand that if I do not submit acceptable supporting documentation, my
request will be denied.
I hereby declare under the penalties of perjury that the statement above is true. I understand I may be contacted
by the Massachusetts Trial Court if additional information is needed.
________________________________
Date of Request
____________________________________________
Registrant’s Signature
Revised 1/2019
Email: exams@jud.state.ma.us
Telephone: (617)742-8575
https://www.mass.gov/jobs-with-the-court-system
Court Officer Entrance Exam 2019
