Qualified Professional Form Page 1 of 4
Qualified Professional Form
Please type or print clearly. You (the candidate) must complete page 1; pages 2 through 4 are to be completed by
your Qualified Professional
. A scanned electronic copy of the completed form should be uploaded into the online
Request Accommodations system in your LSAC account when you submit your online request.
Candidate Name: __________________________________________________________________________________
LSAC Account Number: ____________________________________________ Date of Birth: _____________________
You must present adequate evidence of a disability to support your request. The type and amount of documentation that you
must submit will depend on whether you have prior documentation of a disability determination. Please share these
instructions with anyone who is assisting you with providing supporting documentation.
Note: Documentation submitted in support of a request for testing accommodations should not be more than five
(5) years old for candidates seeking accommodation for mental or cognitive disabilities. Candidates seeking
accommodation for any other disabilities may submit evidence of disability from a Qualified Professional who
examined them any time after they reached the age of 13.
I. Prior Documentation of Disability
A.
Do you have any of the following documentation from a Qualified Professional who previously
examined you within the past five years (if you are seeking accommodation based on mental or
cognitive disabilities) or any time after you reached the age of 13 (if you are seeking accommodation
based on any other disability):
Documentation of disability in previous Individualized Education Program (IEP)
Documentation of disability in previous Section 504 Plan
Documentation of disability in previous Summary of Performance
Documentation of disability in previous Private School Formal Written Plan
Documentation of disability in an outside, private evaluation from a Qualified Professional
Documentation of disability from a Medical Doctor Evaluation or Letter from a Qualified Professional
Yes No
B.
Do you certify that you continue to have this disability?
Yes No
If you answer “yes” to questions I.A. and I.B., upload copies of the relevant documentation with your online
submission.
II. Current Evidence of Disability
If you do not have prior documentation of a disability as set out in Section I, you will need to submit documentation
from a Qualified Professional that you have a disability that restricts your ability to demonstrate your aptitude or
achievement on all or part of the LSAT. Such documentation, when appropriate, may include standardized test data
from appropriate evaluation instruments; a comprehensive evaluation; a relevant history; or a supporting statement
describing the individual’s disability, impairment, areas of limitation, effects on test taking, and testing
accommodation needs (the statement can be provided on page 4). The documentation may also show that you have
a temporary disability, such as a broken bone in your dominant writing hand or a herniated disc, that restricts your
ability to demonstrate your aptitude or achievement on all or part of the LSAT.
If you need to submit current evidence of disability, please have your Qualified Professional fill out the remainder of
this form (pages 2 through 4).
Candidate’s Signature:
I certify that all the information on this statement is true and correct to the best of my knowledge and belief.
_______________________________________________________________ ________________________________
Signature Date
