Application For Testing Accommodations - Form F

FORM F To be completed by law school official (Please print or type) REGARDING THE APPLICATION OF: ___________________________________________ Applicants Name I, _____________________________________, state that my position at (Law school official completing form) _____________________________is________________________________________ (Law School) (Dean/Associate Dean/Registrar) As such, it is my responsibility to authorize any testing accommodations requested by students with disabilities for the specific purpose of allowing such students to take the examinations on an equal basis with other students. The above-named applicant, who (is/was) in attendance at this school (was/was not) given authorization to receive testing accommodations during the administration of examinations at this school. A determination was made that applicant has a disability based upon the following procedure: (Check all that apply) ______ Verification from physician/licensed professional required ______ Student self-reported ______ Special testing was required Applicant was permitted the following accommodation(s): -1- <<<<<<<<<********>>>>>>>>>>>>> 2Were other remediation efforts made? If so, specify how successful they were: I declare under penalty of perjury under the laws of the State of Iowa that the above information is true and correct and that this statement was executed on this ______ day of_______________, at ___________________________________. By ___________________________________ (Signature) Position ______________________________ Address ______________________________ ______________________________ Telephone ____________________________ 2000 -2-