Board of Law Examiners Appointed by the Supreme Court of Texas APPLICATION FOR TESTING ACCOMMODATIONS FOR THE TEXAS BAR EXAMINATION General Instructions These instructions concern Texas Bar Exam testing accommodations for individuals with a disability. Please read all instructions carefully. 1. Attached are: Form A - Applicant Information; Form B - Physical or Psychological Disability Verification; Form C - Learning Disability Verification; Form D - ADHD Verification; Form E - Statement of Law School Official; and Form F - Statement of Another Bar Jurisdiction. If you are seeking testing accommodations only for a learning disability (LD) or Attention Deficit Hyperactivity Disorder (ADHD) or both, then it is not necessary to submit Form B which is for disabilities other than LD or ADHD. Form A must be filed with each application or re-application. Review the application for testing accommodations to determine which forms are applicable to your situation. It is your responsibility to make the correct determination, complete the personal information blocks, send the forms to the appropriate persons for completion, and see that they are timely filed. 2. Because some of the required documentation must be obtained from third parties, you should anticipate this delay and plan accordingly. Please do not call for an extension of time, as no staff member is authorized to grant such an extension. 3. You must file your fully completed application for testing accommodations no later than the date you file your application for the bar examination you wish to take. See Rule XII. 4. You are responsible for meeting the same deadlines for filing the application to take the bar examination as those established for all other applicants. See Rule IX. 5. Carefully review your application for testing accommodations before you submit it to the Board, as it will not be accepted and filed unless all forms are fully completed, signed, notarized where required, and all required documentation is attached. If your testing accommodations application is incomplete, it will be returned to you, unfiled, and will not be considered. 6. Be specific in detailing your request for testing accommodations as to additional time, breaks, large print exams, extension of testing schedule, etc. Only those accommodations actually requested will be considered. 7. You are responsible for all costs you incur in establishing that you are a qualified person with a disability under the ADA. 8. Any disability-related information which you submit to this office and any documentation or information which third parties submit on your behalf will be afforded all confidentiality allowable under applicable laws. 9. You are required to file an Application for Testing Accommodation (Form A) simultaneously with each ReApplication to take the Texas Bar Exam. Do not include additional transcripts, standardized score reports, testing accomm app.pdf (3/2006) i American LegalNet, Inc. www.FormsWorkflow.com or standardized test accommodations notice UNLESS you have taken additional course work at a college or school, or taken additional standardized tests (i.e. provide only NEW data). You do not need to file a new Form B, C, or D UNLESS one of the following apply: a. b. If your ADHD evaluation/testing occurred more than three (3) years prior to the date you file your ReApplication and application for testing accommodations for the exam you intend to take; or, if your Learning Disability evaluation/testing occurred more than five (5) years prior to the date you file your Re-Application and application for testing accommodations for the exam you intend to take, you are required to be re-evaluated and/or retested and file a new Form C or Form D along with the new evaluation/testing documentation. c. If you have taken additional law school courses since the date of your last application for testing accommodations, file a new Form E. d. 10. If you are seeking accommodations other than those previously awarded by the Board, or If you have taken a bar exam in another state since the date of your last application for testing accommodations, file a new Form F. If you are using an electronic version of these forms from the Board’s website, it is your responsibility to ensure that it is printed with the same content and wording as the Board’s printed version of these forms. Do not modify the forms in any way. The Law As an applicant claiming a disability that requires testing accommodations, you must properly complete and submit the forms applicable to your disability. The burden of proof is on you to establish the existence of a disability protected by the Americans with Disabilities Act (the ADA), as well as to establish the need for testing accommodations and the reasonableness of the accommodations requested. Each application for testing accommodations is evaluated on a case-by-case basis. The Board’s objective is to provide effective and necessary accommodations to qualified applicants as defined under the Americans with Disabilities Act of 1990, without substantially altering the nature of the examination. The ADA requires the Board to provide testing accommodations to those individuals who have a permanent disability which substantially limits a major life activity. Although you may provide the required documentation establishing that you have a disability, that does not automatically entitle you to testing accommodations on the Texas Bar Examination. Unless you establish that your disability has substantially impaired a major life activity, you will not be entitled to testing accommodations on the exam. “Testing Accommodation” means an adjustment or modification of the standard testing conditions that ameliorates the impact of the applicant’s disability on the examination process without fundamentally altering the nature of the exam, imposing an undue administrative or financial burden on the Board, compromising the security, validity or reliability of the exam, or providing an unfair advantage to the applicant with the disability. The ADA authorizes the Board to require specific documentation and to establish procedures to evaluate that documentation in order to ensure that the applicant is an individual for whom accommodations are required under the ADA. testing accomm app.pdf (3/2006) ii American LegalNet, Inc. www.FormsWorkflow.com The Application Detailed documentation is required to establish the existence of a disability protected by the ADA and to provide the Board with all necessary information for determining the specific accommodations, if any, which are merited. The pertinent disability verification forms described below must be completed and signed by a professional who is familiar with your disability. The health care provider or other qualified professional must identify your disability, substantiate the diagnosis, describe the functional limitations it imposes on you, and detail the manner in which it limits an identified major life activity. He or she must also make recommendations about the specific accommodations you need on each segment of the examination and provide an explicit rationale for these recommendations. The Application for Testing Accommodations consists of Forms A - F, which are described as follows: Form A -- Applicant Information Form: Every applicant for testing accommodations must complete and file this form, simultaneous with the filing of the application or re-application for the specific exam being taken. Answer the questions in the spaces provided. DO NOT refer to an attachment as a substitute for answering a question in the space provided. Form B -- Physical or Psychological Disability Verification Form: This form must be filed, simultaneous with the filing of the application or re-application for the specific exam being taken, only if the claimed disability is based on a physical disability or psychological disability (other than Learning Disability or Attention Deficit Hyperactivity Disorder). i. Complete the first block of information before submitting the form to your licensed health care provider. ii. This form must be completed by a health care provider with sufficient expertise and credentials in the area of disability you are claiming. You should make sure that you health care provider understands that (s)he must answer each question in the space provided. References to an attached document WILL NOT SUFFICE as a substitute for an answer. However, additional pages may be attached to further explain the answer given in the space provided. iii. This form must document your disability at the current time. iv. Testing and assessment establishing your disability must be conducted by a qualified diagnostician/health care provider. The testing and assessment must have been conducted within three (3) years of the filing of the application for testing accommodations for the specific bar examination for which you are applying. v. Note: you or your physician must submit copies of the actual medical records upon which your physician has relied in responding to Form B. Form C -- Learning Disability Verification Form: This form must be filed, simultaneous with the filing of the application or re-application for the specific exam being taken, ONLY if the claimed disability is based on a learning disability. i. Complete the first block of information before submitting it to your licensed health care provider or other qualified professional, who must have comprehensive training and direct experience in working with the adult population. ii. This form must be completed by a health care provider with sufficient expertise and credentials in the area of disability you are claiming. You should make sure that your health care provider reviews and initials the checklist included at the beginning of the form and understands that in completing the form (s)he must answer each question in the space provided. References to an attached document WILL NOT testing accomm app.pdf (3/2006) iii American LegalNet, Inc. www.FormsWorkflow.com SUFFICE as a substitute for an answer. However, additional pages may be attached to further explain the answer given in the space provided. iii. Please note that you must submit, in addition to the information requested on Form C, a comprehensive psychoeducational or neuropsychological assessment, which demonstrates the impact of your impairment on your ability to perform on each testing component of the Texas Bar Examination under standard time conditions. iv. Your testing and assessment must be conducted by a qualified diagnostician and must have been conducted within five (5) years of the filing of the application for testing accommodations for the specific Texas Bar Examination for which you are applying. v. The documentation must include both diagnostic information and an explanation of the current manifestations or functional limitations of the condition. It should be thorough enough to demonstrate whether or not a major life activity is substantially limited, i.e., the extent, duration, and impact of the condition. vi. If you have been retested, you must submit not only the evaluation and sub-tests from the retesting, but also copies of any previous evaluations and the accompanying sub-tests. Form D -- ADD/ADHD Verification Form: This form must be filed, simultaneous with the filing of the application or re-application for the specific exam being taken, only if your disability is ADD/ADHD. i. Complete the first block of information before submitting this form to your licensed health care provider or other qualified professional, who must have comprehensive training and direct experience in working with the adult population. ii. This form must be completed by a health care provider with sufficient expertise and credentials in the area of disability you are claiming. You should make sure that your health care provider reviews and initials the checklist included at the beginning of the form and understands that in completing the form (s)he must answer each question in the space provided. References to an attached document WILL NOT SUFFICE as a substitute for an answer. However, additional pages may be attached to further explain the answer given in the space provided. iii. Please note that you must submit, in addition to the information requested on Form D, a comprehensive psychoeducational or neuropsychological assessment. This assessment must demonstrate the impact of your impairment on your ability to perform on each testing component of the Texas exam under standard time conditions. iv. Your testing and assessment must be conducted by a qualified diagnostician and must have been conducted within three (3) years of the filing of the application for testing accommodations for the specific Texas Bar Examination for which you are applying. v. The documentation must include both diagnostic information and an explanation of the current manifestations or functional limitations of the condition. It should be thorough enough to demonstrate whether or not a major life activity is substantially limited, i.e., the extent, duration, and impact of the condition. vi. If you have been retested, you must submit not only the evaluation and sub-tests from the retesting, but also copies of any previous evaluations and the accompanying sub-tests. testing accomm app.pdf (3/2006) iv American LegalNet, Inc. www.FormsWorkflow.com Form E -- Statement of Law School Official: This form must be filed, simultaneous with the filing of the application or re-application for the specific exam being taken, regardless of whether you received accommodations in law school or not. i. Complete the first block of information before submitting the form to be completed by the appropriate official at your law school. ii. If you attended more than one law school, you must submit a Form E from each law school attended. Make additional copies of the form if needed. Form F -- Statement of Another Bar Jurisdiction: This form must be filed, simultaneous with the filing of the application or re-application for the specific exam being taken, only if you have applied to take the bar examination in another jurisdiction. i. Complete the first block of information before you submit the form to be completed by the appropriate bar admission official in the other jurisdiction. ii. If you have applied in more than one other jurisdiction, you must submit a Form F from each jurisdiction in which you have applied to take the bar exam regardless of whether you received accommodations on the exam or not. Make additional copies of the form if needed. The Process Your application for testing accommodations and accompanying documentation will be reviewed for completeness shortly after it is filed. Before making a decision regarding your accommodations, the Board’s staff may submit your application for testing accommodations and the accompanying documentation to an expert of the Board’s choice for evaluation and recommendations. After all of your testing accommodations application materials have been appropriately evaluated, you will receive a letter from the Board telling you whether you have been granted testing accommodations. Testing accommodations applications are processed in the order received. Therefore, the earlier you file your application for testing accommodations, the earlier you will receive notification of whether your application has been granted or not. If your application for accommodations is granted, you will receive a letter from the Board detailing the accommodations granted and including a written agreement for you to sign and return if you accept the terms of the testing accommodations. The Appeal Procedure If your application for testing accommodations is denied in whole or in part, you may appeal the decision of the staff to the Accommodations Review Committee (ARC) of the Board. In order to appeal, you must send a letter addressed to the Executive Director of the Board, stating the specific basis of your appeal. Your appeal letter must reach the Board’s office no later than the date specified in the partial grant or denial letter. The appeal will be considered by the ARC of the Board of Law Examiners in a meeting held in compliance with applicable state law. An appeal of testing accommodations is not a hearing at which new evidence is produced or oral arguments made. It is a review, by the members of the ARC, of the record in the Board’s file relating to your application for testing accommodations, including your application and other materials required to be provided with your application, the medical and other records submitted in support of the application, and the follow-up information generated as a result of your application for testing accommodations. testing accomm app.pdf (3/2006) v American LegalNet, Inc. www.FormsWorkflow.com Questions Any questions about the testing accommodations application process should be directed to: Josh Henslee, Director of Eligibility & Examination, Board of Law Examiners, P.O. Box 13486, Austin, Texas 78711-3486. testing accomm app.pdf (3/2006) vi American LegalNet, Inc. www.FormsWorkflow.com Board of Law Examiners Appointed by the Supreme Court of Texas APPLICATION FOR TESTING ACCOMMODATIONS FOR THE TEXAS BAR EXAMINATION FORM A APPLICANT INFORMATION FORM This application, complete with all applicable forms and required documentation, MUST be filed at the SAME TIME you file your application to take the examination, or it will not be processed. See Rule XII(b), Rules Governing Admission to the Bar of Texas. Please note that it is your responsibility to read and follow all of the instructions attached to this application. Failure to do so may result in the rejection of your application for testing accommodations or the denial of such accommodations. DO NOT LEAVE ANY BLANKS! DO NOT ANSWER, “SEE ATTACHED.” BACKGROUND INFORMATION: Applicant Name __________________________________________________________________________ Last First Middle Mailing Address _________________________________________________________________________ Street Address or PO Box ________________________________________________________________________ City State Zip Code Phone: (_____) ________________ Fax: (_____) _________________ E-mail: ______________________ Exam Applying for (specify “February” or “July” and the year) :______________________________________ Exam Site: _____________________________ (1st choice) ____________________________ (2nd choice) NATURE OF MY DISABILITY (Check all that apply; only disabilities noted here will be considered.) ____ attention deficit hyperactivity disorder (ADHD) ____ psychological disability: __________________ ____ hearing disability ____ visual disability: ________________________ ____ learning disability (LD) ____ other: _______________________________ ____ physical disability: ______________________ testing accomm app.pdf (3/2006) _______________________________ 1A American LegalNet, Inc. www.FormsWorkflow.com HISTORY OF MY DISABILITY 1. I was professionally diagnosed with ________________________________________ (state specific diagnosis) in _______________ (month), ____________ (year) . This disability is temporary / permanent (circle one). 2. The diagnosis was made by: Health care provider: ______________________________________ Type of health care provider: ________________________________ Current address: __________________________________________ ________________________________________________________ Current phone number: ( ) Fax: ( ) I last consulted a health care provider regarding this disability on _______________ (month), _________ (year). 3. My specific concern at the time of my last consultation was ___________________________________. 4. At that time, I consulted with: Health care provider: _______________________________________ Type of health care provider: _________________________________ Current address: __________________________________________ ________________________________________________________ Current phone number: ( 5. ) Fax: ( ) I received accommodations for my disability as indicated by the boxes I have checked below: ___ accommodations on standardized exams that are circled: SAT ACT GRE GMAT LSAT MPRE NOTE: Attach a copy of the notice of approved accommodations issued by the testing entity AND a copy of official score reports for each such exam on which you received accommodations. ___ the use of disabled-student services while I was in college ___ testing accommodations while in undergraduate school NOTE: Attach a copy of the notice of approved accommodations granted by each college or university attended. ___ testing accommodations while I was in law school NOTE: Attach a copy of the notice of testing accommodations granted by each law school attended. testing accomm app.pdf (3/2006) 2A American LegalNet, Inc. www.FormsWorkflow.com ___ testing accommodations on a bar examination in another state. NOTE: Attach a copy of the notice of testing accommodations granted by each jurisdiction in which a bar exam was taken. 6. If you have not received accommodations for your disability in the past, provide a complete statement of why that was the case and why accommodations are needed now. Explanation: ACCOMMODATIONS REQUESTED 7. Check all that apply. Only those accommodations actually requested here will be considered. ___ Additional testing time, as indicated on the charts below, where I have specified for each segment of the examination both the amount of additional time requested and the rationale for the request. ___ braille version of exam ___ large print exam materials: Circle one: 18 point ___ use of reader ___ use of court reporter ___ audio cassette version of exam ___ separate testing area ___ food and beverage during exam 24 point ___ medication and water during exam (Standard font size is 12 point.) ___ use of magnifying glass or special visual aid/apparatus (specify below) ___ assistance in filling in MBE grid ___ other:____________________________ ___ other:____________________________ ___ other:____________________________ ___ use of sign language interpreter 8. ___ printed copy of verbal instructions ___ other:____________________________ For each requested accommodation other than additional time (which is covered in question 9), clearly and distinctly state the specific reason you need such accommodation. Accommodation requested Specific rationale for accommodation Continue your answer on a separate sheet of paper if you need more space. testing accomm app.pdf (3/2006) 3A American LegalNet, Inc. www.FormsWorkflow.com 9. If you checked the box requesting additional testing time, complete the following charts. If all four charts below are not FULLY completed, your request for additional testing time will not be considered or processed, and no additional time will be granted. Day 1, Segment 1: Multistate Performance Test (MPT) 90-minute writing project (lawyering skills) Additional time requested Recommend: ½ for reading/organizing, ½ for writing Specific rationale for additional testing time on this segment Day 1, Segment 2: Procedure & Evidence Questions (P&E) 90-minute short answer exam Additional time requested Specific rationale for additional testing time on this segment Day 2: Multistate Bar Examination (MBE) 200-question standardized test divided into two 3-hour sessions Additional time requested per 3-hour session Specific rationale for additional testing time on this segment Day 3: Texas Essays 12 essay questions in 6 subject areas, divided into two 3-hour sessions Additional time requested per 3-hour session testing accomm app.pdf (3/2006) Specific rationale for additional testing time on this segment 4A American LegalNet, Inc. www.FormsWorkflow.com REQUIRED DOCUMENTATION PROVIDED I acknowledge attaching to my Form A, application for testing accommodations, the following items which are required in order for the Board to process my application for testing accommodations, and I understand that my application will be returned to me if any of these items are not filed either with or before the filing of my application for testing accommodations. You MUST provide copies of test scores and supporting documentation for any accommodations that you have received. Even if you did not receive accommodations on the LSAT, you MUST provide the LSAT score report for review. Even if you did not receive accommodations in undergraduate school, graduate school (if you attended), or law school, you MUST provide transcripts for each school attended. Place a check mark beside each item you have previously supplied or which you currently are supplying with your Form A. _____ If I am claiming a physical or psychological disability, a fully completed Form B, including copies of all records specified as required in Form B _____ If I am claiming a learning disability, a fully completed Form C, including copies of all records specified as required in Form C _____ If I am claiming an ADD/ADHD disability, a fully completed Form D, including copies of all records specified as required in Form D _____ For each law school attended, a fully completed Form E, including copies of all records and documentation requested in Form E _____ For each jurisdiction outside Texas to which I have applied, a fully completed Form F, including copies of all records and documentation requested in Form F _____ A copy of the official notice of testing accommodations granted for each standardized exam circled on page 2A of this form _____ A copy of the official score report for each standardized exam circled on page 2A of this form _____ A copy of notice of approved accommodations granted by each undergraduate college or university attended _____ Copy of official score report for LSAT, regardless of whether I took the LSAT under testing accommodations _____ An official copy of all of my undergraduate transcript(s) _____ An official copy of all of my graduate school transcript(s) _____ An official copy of all of my law school transcript(s) testing accomm app.pdf (3/2006) 5A American LegalNet, Inc. www.FormsWorkflow.com VERIFICATION I declare under the penalty of perjury that all of the information provided in connection with my application for testing accommodations is true and correct. I seek admission to the Texas Bar Examination upon completion of the law study requirement and other requirements imposed by the Rules Governing Admission to the Bar of Texas. Having read the Rules Governing Admission to the Bar of Texas, I am submitting my application for testing accommodations in the good faith belief that I am eligible for admission to the Texas Bar Examination and that I will make an honest effort to complete all parts of the examination. I understand that this application may result in the setting aside of resources, facilities, time and personnel to accommodate my disability or condition, and I agree to notify the Board of Law Examiners promptly if for any reason I decide to withdraw this application or withdraw from the exam. I understand that both my application for testing accommodations and all the supporting documentation required by the Board may be submitted to third party experts retained by the Texas Board of Law Examiners, and I authorize such communication. I understand that all of the documentation specified as being required in this Application for Testing Accommodations is an integral part of the application. I acknowledge that I have been informed that my application for testing accommodations will not be considered unless all of the documentation is filed no later than the time I file my application to take the examination. If testing accommodations are provided to me which include any deviation from the standard testing time schedule, I agree that from the time I begin the examination until I have completed the entire examination, I will not communicate in any way, to the extent possible, with any other individuals taking the examination and that I will not communicate in any way with any such individuals about the contents of the examination. I further declare that, having submitted the foregoing form(s) using the Board’s web version, no revisions or alterations have been made to the text or questions contained therein; and that if revisions or alterations are made, it is understood by me that the form(s) may be rejected. _____________________________________________ _______________________________________ (Signature) (Date) Subscribed and sworn to before me this ____________ day of ________________________ , __________. (SEAL) _______________________________________________ Signature of Notary testing accomm app.pdf (3/2006) 6A American LegalNet, Inc. www.FormsWorkflow.com APPLICANT’S NARRATIVE STATEMENT OF IMPAIRMENT Use this page if you are handwriting your narrative; use the following page if you are typing your narrative. Name Provide a detailed personal statement describing how your disability substantially limits a major life activity. Be sure to specify the major life activity which is impaired. Limit your statement to this one page. Personal statement: 7A-Handwritten testing accomm app.pdf (3/2006) American LegalNet, Inc. www.FormsWorkflow.com APPLICANT’S NARRATIVE STATEMENT OF DISABILITY Use this page if you are typing your narrative; use the preceding page if you are writing your narrative. Name Provide a detailed personal statement describing how your disability substantially limits a major life activity. Be sure to specify the major life activity which is impaired. Limit your statement to this one page. PERSONAL STATEMENT 8A-Typed testing accomm app.pdf (3/2006) American LegalNet, Inc. www.FormsWorkflow.com Board of Law Examiners Appointed by the Supreme Court of Texas APPLICATION FOR TESTING ACCOMMODATIONS FOR THE TEXAS BAR EXAMINATION FORM B PHYSICAL OR PSYCHOLOGICAL DISABILITY VERIFICATION FORM (Do not use this form to verify ADD/ADHD or LD disabilities; separate forms are provided for those disabilities.) (This box should be completed by the applicant seeking testing accommodations before providing the form to the licensed physician or other health care provider for completion. This form MUST be filed with Form A at the same time the Application for Admission is filed.) Applicant:____________________________________________________________________________ Street Address City State Zip Date of birth: ___________________________ SSN*________________________________________ I hereby consent to the release of the information, reports, and records requested in this form, and I request that all such items be attached to this form and returned to me for provision to the Texas Board of Law Examiners, or in the alternative, mailed directly to the Texas Board of Law Examiners, P.O. Box 13486, Austin, Texas 78711-3486. In any event, it is imperative that this completed form be returned to me as soon as possible so that I can file it with my application for testing accommodations. Signature of Applicant___________________________________________________________________Date________________________ Subscribed and sworn to before me this __________ day of _____________________________, ________. (SEAL) ___________________________________________________ Signature of Notary * The provision of your SSN is voluntary, pursuant to Sec. 7, Privacy Act of 1974. If this data is provided, the Board will use it in its investigation and verification, so as to avoid errors which might introduce problems and delays into the certification and licensure process. The Board appreciates your furnishing this information on a voluntary basis. NOTICE: The remainder of this form must be completed by a licensed physician or other licensed health care provider. It is important that the information be typed or PRINTED LEGIBLY. Please include the information requested in the spaces provided. YOU MUST ANSWER EACH QUESTION IN THE SPACE PROVIDED. DO NOT answer these inquiries with a notation referring to attached records. LICENSED PHYSICIAN OR OTHER HEALTH CARE PROVIDER Name: Current Position: Address: Street address City State Zip Telephone Number:________________________________Fax Number:_______________________________ (Jurisdiction) License/Certification Number: (___________________)__________________________________ Name and Address of Licensing Entity: testing accomm app.pdf (3/2006) 1B American LegalNet, Inc. www.FormsWorkflow.com 1. Is the Applicant’s disability within your field of expertise? __________________________ describe the credentials which qualify you to diagnose and/or verify the Applicant’s disability. If so, please 2. Please describe your credentials in the area of testing, statistical measurement, or psychometrics. 3. Please describe the training you have had in the area of making recommendations for specific time accommodations on examinations such as the Texas Bar Examination. INFORMATION CONCERNING APPLICANT’S DISABILITY 4. State the specific diagnosis of the disability affecting Applicant. 5. When was the Applicant first diagnosed with this condition? 6. Did you make the initial diagnosis? ___ Yes testing accomm app.pdf (3/2006) ___ No 2B American LegalNet, Inc. www.FormsWorkflow.com 7. If not, please state the name, address, and telephone number of the professional who made the initial diagnosis: 8. In the following box, describe the specific diagnostic criteria and/or diagnostic tests used, including date(s) of evaluation, test results, and a detailed interpretation of test results. Please note that you must also attach to this form or provide directly to the Board a complete copy of the testing and assessment tools conducted, as well as copies of your notes and other records relating to the Applicant. Continue on a separate page if you need more space. 9. State the date the last testing and assessment of Applicant’s disability was completed: _________________ 10. State each date you have seen the Applicant for a consultation: _________________________________ 11. When was your last complete evaluation of the Applicant? _______________________________________ 12. What occasioned this evaluation (i.e., specific health complaints, need for updated evaluation for accommodations, etc.)? ______________________________________________________________ 13. Briefly describe your treatment of this disability or condition, and state the effect of the treatment on the disability or condition: testing accomm app.pdf (3/2006) 3B American LegalNet, Inc. www.FormsWorkflow.com 14. State each medication the Applicant is taking for this disability or condition, and describe how this medication affects, abates, treats the disability or condition. 15. Summarize any side effects your patient has experienced with this medication, specifically including any which will affect his or her performance on the Texas Bar Examination. 16. In its current state, is the Applicant’s disability temporary or permanent? ___ permanent ___ temporary 17. If you indicated the disability to be temporary, state when and under what conditions the disability/condition is likely to abate. 18. Describe in detail any major life activities which are substantially limited by Applicant’s diagnosed disability at the current time . If there are none, please so state. RECOMMENDED TESTING ACCOMMODATIONS As background for the specific inquiries we make concerning Applicant’s need for testing accommodations on the 2½ day Texas Bar Examination (TBE), we are providing you with the following description of the TBE, as well as the standard testing conditions under which it is administered. A. Day One consists of one 3-hour testing session in the morning, during which the following two 90minute test segments are administered. There is no afternoon testing session; applicants have this afternoon off. testing accomm app.pdf (3/2006) 4B American LegalNet, Inc. www.FormsWorkflow.com 1. Multistate Performance Test: This 90-minute test on fundamental lawyering skills involves a writing project. Applicants are provided with a set of facts, a library of cases and/or statutes, and an assignment to perform a lawyerly task using the materials provided. The official instructions advise the applicant to allocate half of this time for reading and organizing and half of it for actual writing of the project. The answer booklet provided for the project contains 12 pages, each with 18 lines. Applicants do not typically fill the complete answer booklet. 2. Procedure & Evidence Questions: This 90 minute test consists of 40-50 objective, short answer questions. Applicants must limit each answer to the five (5) lines provided after each question. B. Day Two consists of one 3-hour morning session and one 3-hour afternoon session, with a 1-1½ hour lunch break between sessions. During each session, Applicants are administered a 100-question multiple choice examination which must be answered by “bubbling” in answers on a computer-graded grid sheet. C. Day Three also consists of one 3-hour morning session and one 3-hour afternoon session, with a 11½ hour lunch break in between sessions. During each session, Applicants are administered an essay test consisting of six essay questions in various subject matters. During each session, the applicant is provided with six (6 page, 18 lines each) answer booklets, in each of which the applicant writes 1 essay. D. The typical physical testing environment consists of a large room in which 150 - 800 applicants are seated in assigned seats, two to a 6-8' table. Examinees are not allowed to have food or drink in the testing room; they are allowed to leave the room to go to the restroom or to the water fountain. 19. Provide an explanation as to how specific aspect(s) of the Applicant’s disability affect(s) the Applicant’s ability to take various segments of the Texas Bar Examination under the standard testing conditions. Day 1; Multistate Performance Test: Day 1; Procedure & Evidence Questions: testing accomm app.pdf (3/2006) 5B American LegalNet, Inc. www.FormsWorkflow.com Day 2; Multistate Bar Examination: Day 3; Texas Essays: 20. Based on the information provided about the Texas Bar Examination above, what testing accommodations do you recommend for the Applicant? (Check all accommodations you believe are necessary.) ___ Additional testing time, as indicated on the charts below, where I have specified for each segment of the examination both the amount of additional time requested and the rationale for the request. ___ braille version of exam ___ printed copy of verbal instructions ___ use of reader ___ use of court reporter ___ audio cassette version of exam ___ separate testing area ___ large print exam materials: Circle one: 18 point ___ food and beverage during exam 24 point ___ medication and water during exam (Standard font size is 12 point.) ___ other: __________________________ ___ use of magnifying glass or special visual aid/apparatus (specify below) ___ other: __________________________ ___ assistance in filling in MBE grid ___ other: __________________________ ___ use of sign language interpreter ___ other: __________________________ testing accomm app.pdf (3/2006) 6B American LegalNet, Inc. www.FormsWorkflow.com 21. For each recommended accommodation other than additional time (which is covered in the following question), clearly and distinctly state the specific reason you recommend such accommodation. Accommodation recommended Specific rationale for accommodation Continue your answer on a separate sheet of paper if you need more space. 22. If you checked the box recommending additional testing time, complete the following charts. Please note that all four charts must be fully completed. Day 1, Segment 1: Multistate Performance Test (MPT) 90-minute writing project (lawyering skills) Additional time recommended Recommend: ½ for reading/organizing, ½ for writing Specific rationale for additional testing time on this segment Day 1, Segment 2: Procedure & Evidence Questions (P&E) 90-minute short answer exam Additional time recommended testing accomm app.pdf (3/2006) Specific rationale for additional testing time on this segment 7B American LegalNet, Inc. www.FormsWorkflow.com Day 2: Multistate Bar Examination (MBE) 200-question standardized test divided into two 3-hour sessions Additional time recommended per 3-hour session Specific rationale for additional testing time on this segment Day 3: Texas Essays 12 essay questions in 6 subject areas, divided into two 3-hour sessions Additional time recommended per 3-hour session Specific rationale for additional testing time on this segment 23. If you based your recommendations regarding additional testing time on Applicant’s reduced handwriting speed or ability, please describe all tests conducted by you or relied on by you to determine the speed at which the Applicant writes, as compared to that of a person without Applicant’s disability. 24. Is there any medical or scientific study you can cite which provided you with data enabling you to determine on an objective basis the exact amount of additional testing time which will place the Applicant in a testing position akin to that enjoyed by a person who does not have this disability? ___ YES ___ NO 25. If you answered “YES” to the preceding question, please attach a copy of the study to this form. In the space below, describe how the study supports the accommodations you have recommended for Applicant. testing accomm app.pdf (3/2006) 8B American LegalNet, Inc. www.FormsWorkflow.com REQUIRED DOCUMENTATION AND VERIFICATION I have attached to this Form B copies of all records in my possession or control on which I have relied in answering the inquiries on this form. If there is some ethical or professional reason that I cannot attach the required records to this Form B for return to the Applicant, I hereby certify that I will mail the required records directly to the Texas Board of Law Examiners, directed to the attention of the Director of Examination & Eligibility, at the following address: P.O. Box 13486, Austin, Texas 78711-3486. I understand that the Applicant’s request for testing accommodations will not be processed without these records. I understand that this completed Form B must be filed by the Applicant at the same time as the Applicant files his/her application for admission to take the Texas Bar Examination, and that stringent deadlines apply to such filing. I certify that the information provided by me on this form is true and correct to the best of my knowledge. I understand that a representative or agent of the Texas Board of Law Examiners may contact me for clarification of my responses on this form. Date Signature of Licensed Physician/Licensed Professional testing accomm app.pdf (3/2006) 9B American LegalNet, Inc. www.FormsWorkflow.com Board of Law Examiners Appointed by the Supreme Court of Texas APPLICATION FOR TESTING ACCOMMODATIONS FOR THE TEXAS BAR EXAMINATION FORM C LEARNING DISABILITY VERIFICATION FORM (This box should be completed by the applicant seeking testing accommodations before providing the form to the licensed physician or other health care provider for completion. This form MUST be filed with Form A at the same time the Application for Admission is filed.) Applicant:______________________________________________________________________________ ___________________________________________________________________________________ Street Address City State Zip Date of birth: _______________________________ SSN*_____________________________________ I hereby consent to the release of the information, reports, and records requested in this form, and I request that all such items be attached to this form and returned to me for provision to the Texas Board of Law Examiners, or in the alternative, mailed directly to the Texas Board of Law Examiners, P.O. Box 13486, Austin, Texas 78711-3486. In any event, it is imperative that this completed form be returned to me as soon as possible so that I can file it with my application for testing accommodations. Signature of Applicant___________________________________________________________________Date________________________ Subscribed and sworn to before me this __________ day of ______________________________, ________. (SEAL) ___________________________________________________ Signature of Notary *The provision of your SSN is voluntary, pursuant to Sec. 7, Privacy Act of 1974. If this data is provided, the Board will use it in its investigation and verification, so as to avoid errors which might introduce problems and delays into the certification and licensure process. The Board appreciates your furnishing this information on a voluntary basis. NOTICE: The remainder of this form must be completed by a licensed physician or other licensed health care provider qualified to diagnose and treat adults with a learning disability. It is important that the information be typed or printed legibly. PLEASE INCLUDE THE INFORMATION REQUESTED IN THE SPACES PROVIDED. DO NOT answer these inquiries with a notation referring to attached records. An applicant with a specific learning disability must have been identified by an approved psycho-educational assessment process which includes data from both cognitive and achievement measures. In addition, all such testing must also: 1. have been administered within the last five (5) years; 2. have identified an information processing deficit; 3. have certified that this patient’s aptitude is within the normal range; and 4. have identified an aptitude-achievement discrepancy of 1.5 standard deviations. testing accomm app.pdf (3/2006) 1C American LegalNet, Inc. www.FormsWorkflow.com LICENSED PHYSICIAN OR OTHER HEALTH CARE PROVIDER Name: ______________________________________________________________________________ Current Position: ______________________________________________________________________ Address: _____________________________________________________________________________ Street address City State Zip Telephone Number:________________________________ Fax number:______________________________ (Jurisdiction) License/Certification Number:(____________________) ________________________________ Name and Address of Licensing Entity: _______________________________________________________ ____________________________________________________________________________________ Please initial in the spaces provided below beside items 1-8 and sub-parts 3 a-c to affirm that you have read them before completing the remainder of Form C. You may make a copy for your records. ______ 1. The evaluation must be conducted by a qualified professional. The diagnostician must have comprehensive training in the field of learning disabilities and must have comprehensive training and direct experience in working with an adult population. ______ 2. Testing/assessment must be current. The determination of whether an individual is significantly limited in functioning is based on assessment of the current impact of the impairment. A developmental disorder such as a learning disability originates in childhood and, therefore, information which demonstrates a history of impaired functioning should also be provided. ______ 3. Documentation must be comprehensive. Objective evidence of a substantial limitation in cognition or learning must be provided. At a minimum, the comprehensive evaluation should include the following: ______ a. testing accomm app.pdf (3/2006) A diagnostic interview and history taking Because learning disabilities are commonly manifested during childhood, though not always formally diagnosed, relevant historical information regarding the individual’s academic history and learning processes in elementary, secondary and post-secondary education should be investigated and documented. The report of assessment should include a summary of a comprehensive diagnostic interview that includes relevant background information to support the diagnosis. In addition to the candidate’s self-report, the report of assessment should include: i. A description of the presenting problem(s) ii. A developmental history iii. Relevant academic history including results of prior standardized testing, reports of classroom performance and behaviors including transcripts, study habits and attitudes and notable trends in academic performance 2C American LegalNet, Inc. www.FormsWorkflow.com iv. Relevant family history, including primary language of the home and current level of fluency in English v. Relevant psychosocial history vi. Relevant medical history including the absence of a medical basis for the present symptoms vii. Relevant employment history viii. A discussion of dual diagnosis, alternative or co-existing mood, behavioral, neurological and/or personality disorders along with any history of relevant medication and current use that may impact the individual’s learning ix. Exploration of possible alternatives that may mimic a learning disability when, in fact, one is not present. ______ b. A psychoeducational or neuropsychological evaluation The psychoeducational or neuropsychological evaluation must be submitted on the letterhead of a qualified professional and it must provide clear and specific evidence that a learning or cognitive disability does or does not exist. i. ii. iii. iv. ______ c. Minimally, the domains to be addressed should include the following: i. ii. testing accomm app.pdf (3/2006) Assessment must consist of a comprehensive battery of tests A diagnosis must be based on the aggregate of test results, history and level of current functioning. It is not acceptable to base a diagnosis on only one or two subtests. Objective evidence of a substantial limitation in learning must be presented. Tests must be appropriately normed for the age of the patient and must be administered in the designated standardized manner. Cognitive Functioning A complete cognitive assessment is essential with all subtests and standard scores reported. Acceptable measures include but are not limited to: Wechsler Adult Intelligence Scale-III (WAIS-III); Woodcock Johnson Psychoeducational Battery - III (WJ-III): Tests of Cognitive Ability; Kaufman Adolescent and Adult Intelligence Test. Achievement A comprehensive achievement battery with all subtests and standard scores is essential. The battery must include current levels of academic functioning in relevant areas such as reading (decoding and comprehension) and writing. Acceptable instruments include, but are not limited to, the Woodcock-Johnson Psychoeducational Battery - III (WJ-III): Tests of Achievement; The Scholastic Abilities Test for Adults (SATA); Woodcock Reading Mastery Tests-Revised. Specific achievement tests are useful instruments when administered under standardized conditions and when interpreted within the context of other diagnostic information. The Wide Range Achievement Test-3 (WRAT-3) and the Nelson-Denny Reading Test are not comprehensive diagnostic measures of achievement and therefore neither is acceptable if used as the sole measure of achievement. 3C American LegalNet, Inc. www.FormsWorkflow.com iii. iv. Information Processing Specific areas of information processing (e.g., short- and long-term memory, sequential memory, auditory and visual perception/processing, auditory and phonological awareness, processing speed, executive functioning, motor ability) must be assessed. Acceptable measures include, but are not limited to, the Detroit Tests of Learning Aptitude - Adult (DTLA-A), Wechsler Memory Scale-III (WMS-III), information from the Woodcock Johnson Psychoeducational Battery - III (WJ-III): Tests of Cognitive Ability, as well as other relevant instruments that may be used to address these areas. Other Assessment Measures Other formal assessment measures or nonstandard measures and informal assessment procedures or observations may be integrated with the above instruments to help support a differential diagnosis or to disentangle the learning disability from coexisting neurological and/or psychiatric issues. In addition to standardized test batteries, nonstandardized measures and informal assessment procedures may be helpful in determining performance across a variety of domains. ______ 4. Actual test scores must be provided (standard scores where available) as well as identification of norms used to interpret the data. It is helpful to list all test data in a score summary sheet appended to the evaluation. ______ 5. Records of academic history should be provided. Because learning disabilities are most commonly manifested during childhood, relevant records detailing learning processes and difficulties in elementary, secondary and postsecondary education should be included. Such records as grade reports, transcripts, teachers’ comments and the like will serve to substantiate self-reported academic difficulties in the past and currently. ______ 6. A differential diagnosis must be reviewed and various possible alternative causes for the identified problems in academic achievement should be ruled out. The evaluation should address key constructs underlying the concept of learning disabilities and provide clear and specific evidence of the information processing deficit(s) and how these deficits currently impair the individual’s ability to learn. No single test or subtest is a sufficient basis for a diagnosis. The differential diagnosis must demonstrate that: a. Significant difficulties persist in the acquisition and use of listening, speaking, reading, writing or reasoning skills. b. The problems being experienced are not primarily due to lack of exposure to the behaviors needed for academic learning or to an inadequate match between the individual's ability and the instructional demands. ______ 7. A clinical summary must be provided. A well-written diagnostic summary based on a comprehensive evaluative process is a necessary component of the report. Assessment instruments and the data they provide do not diagnose; rather, they provide important data that must be integrated with background information, historical information and current functioning. It is essential then that the evaluator integrate all information gathered in a well-developed clinical summary. The following elements must be included in the clinical summary: testing accomm app.pdf (3/2006) 4C American LegalNet, Inc. www.FormsWorkflow.com a. b. c. d. Demonstration of the evaluator’s having ruled out alternative explanations for the identified academic problems as a result of poor education, poor motivation and/or study skills, emotional problems, attentional problems and cultural or language differences; Indication of how patterns in cognitive ability, achievement and information processing are used to determine the presence of a learning disability; Indication of the substantial limitation in learning presented by the learning disability and the degree to which it impacts the individual in the context of the professional licensing exam administered by the Texas Board of Law Examiners. Indication as to why specific accommodations are needed and how the effects of the specific disability are mediated by the recommended accommodation(s). Problems such as test anxiety, English as a second language (in and of itself), slow reading without an identified underlying cognitive deficit or failure to achieve a desired academic outcome are not learning disabilities and therefore are not covered under the Americans with Disabilities Act. ______ 1. 8. Each accommodation recommended by the evaluator must include a rationale. The evaluator must describe the impact the diagnosed learning disability has on a specific major life activity as well as the degree of significance of this impact on the individual. The diagnostic report must include specific recommendations for accommodations and a detailed explanation as to why each accommodation is recommended. Recommendations must be tied to specific test results or clinical observations. The documentation should include any record of prior accommodation or auxiliary aids, including any information about specific conditions under which the accommodations were used and whether or not they were effective. However, a prior history of accommodation, without demonstration of a current need, does not in and of itself warrant the provision of a like accommodation. If no prior accommodation(s) has been provided, the qualified professional expert should include a detailed explanation as to why no accommodation(s) was used in the past and why accommodation(s) is needed at this time. Describe the credentials which qualify you to diagnose and/or verify the Applicant’s learning disability. Please note that in order to be considered qualified you must have comprehensive training in the field of learning disabilities in general, and you must have comprehensive training and direct experience in working with an adult population. Be sure to include in your description sufficient information about these aspects of your credentials. testing accomm app.pdf (3/2006) 5C American LegalNet, Inc. www.FormsWorkflow.com 2. Describe your credentials in the area of testing, statistical measurement, or psychometrics. 3. Describe the training you have had in the area of making recommendations for specific time accommodations on examinations such as the Texas Bar Examination. INFORMATION CONCERNING THE APPLICANT’S LEARNING DISABILITY 4. State the specific diagnosis of the disability affecting Applicant. _________________________________ __________________________________________________________________________________ 5. When was Applicant first diagnosed with this condition? _______________________________________ 6. Did you make the initial diagnosis? ___ Yes 7. If not, please state the name, address, and telephone number of the professional who made the initial diagnosis: ___ No __________________________________________________________________________________ __________________________________________________________________________________ ___________________________________________________________________________________ 8. In the following box, describe the specific diagnostic criteria and/or diagnostic tests used to diagnose Applicant, including date(s) of evaluation, test results, and a detailed interpretation of test results. Please note that you must attach to this form or provide directly to the Board a complete copy of the evaluation and assessment tools conducted, as well as copies of your notes and other records relating to the Applicant. Continue on a separate page if you need more space. testing accomm app.pdf (3/2006) 6C American LegalNet, Inc. www.FormsWorkflow.com 9. State the date that cognitive assessment on Applicant was completed: ____________________________ 10. State the date that achievement assessment on Applicant was completed: __________________________ 11. List all of Applicant’s test scores which document that Applicant is 1.5 standard deviations below aptitude. 12. State each date you have seen Applicant for a consultation: ____________________________________ __________________________________________________________________________________ 13. When was your last complete evaluation of the Applicant? _____________________________________ 14. What occasioned this evaluation (i.e., specific complaints, need for updated evaluation for accommodations, etc.)? ___________________________________________________________________________ 15. Briefly describe your treatment of this disability or condition and the effect of the treatment on the disability or condition. 16. State each medication you have prescribed for this disability or condition, and describe how this medication affects, abates, treats the disability or condition. testing accomm app.pdf (3/2006) 7C American LegalNet, Inc. www.FormsWorkflow.com 17. Summarize any side effects your patient has experienced with any of these medications, specifically including any which will affect his or her performance on the Texas Bar Examination. 18. In its current state, is the Applicant’s disability temporary or permanent? ___ permanent ___ temporary 19. If you indicated the disability to be temporary, state when and under what conditions the disability/condition is likely to abate. _____________________________________________________________________ _________________________________________________________________________________ ________________________________________________________________________________ 20. Describe in detail any major life activities (i.e., seeing, hearing, learning, etc.) which are substantially limited by the Applicant’s diagnosed disability at the current time . If there are none, please so state. RECOMMENDED TESTING ACCOMMODATIONS As background for the specific inquiries we make concerning Applicant’s need for testing accommodations on the 2½ day Texas Bar Examination (TBE), we are providing you with the following description of the TBE, as well as the standard testing conditions under which it is administered. A. Day One consists of one 3-hour testing session in the morning, during which the following two 90minute test segments are administered. There is no afternoon testing session; applicants have this afternoon off. 1. Multistate Performance Test: This 90-minute test on fundamental lawyering skills involves a writing project. Applicants are provided with a set of facts, a library of cases and/or statutes, and an assignment to perform a lawyerly task using the materials provided. The official instructions advise the applicant to allocate half of this time for reading and organizing and half of it for actual writing of the project. The answer booklet provided for the project contains 12 pages, each with 18 lines. Applicants do not typically fill the complete answer booklet. testing accomm app.pdf (3/2006) 8C American LegalNet, Inc. www.FormsWorkflow.com 2. Procedure & Evidence Questions: This 90 minute test consists of 40-50 objective, short answer questions. Applicants must limit each answer to the five (5) lines provided after each question. B. Day Two consists of one 3-hour morning session and one 3-hour afternoon session, with a 1-1½ hour lunch break in between sessions. During each session, Applicants are administered a 100-question multiple choice examination which must be answered by “bubbling” in answers on a computer-graded grid sheet. C. Day Three also consists of one 3-hour morning session and one 3-hour afternoon session, with a 11½ hour lunch break in between sessions. During each session, Applicants are administered an essay test consisting of six essay questions in various subject matters. During each session, the applicant is provided with six (6 page, 18 lines each) answer booklets, in each of which the applicant writes 1 essay. D. The typical physical testing environment consists of a large room in which 150 - 800 applicants are seated in assigned seats, two to a 6-8' table. Examinees are not allowed to have food or drink in the testing room; they are allowed to leave the room to go to the restroom or to the water fountain. 21. Provide an explanation as to how specific aspect(s) of Applicant’s disability affect(s) Applicant’s ability to take the various segments of the Texas Bar Examination under the standard testing conditions. Day 1; Multistate Performance Test: Day 1; Procedure & Evidence Questions: testing accomm app.pdf (3/2006) 9C American LegalNet, Inc. www.FormsWorkflow.com Day 2; Multistate Bar Examination: Day 3; Texas Essays: 22. Based on the information provided about the Texas Bar Examination above, what testing accommodations do you recommend for Applicant? (Check all accommodations you believe are necessary.) ___ Additional testing time, as indicated on the charts below, where I have specified for each segment of the examination both the amount of additional time requested and the rationale for the request. ___ ___ ___ ___ ___ ___ ___ ___ ___ braille version of exam ___ large print exam materials: Circle one: 18 point 24 point ___ other: __________________________ (Standard font size is 12 point.) ___ other: __________________________ ___ use of magnifying glass or special visual aid/apparatus (specify below) ___ assistance in filling in MBE grid testing accomm app.pdf (3/2006) use of sign language interpreter printed copy of verbal instructions use of reader use of court reporter audio cassette version of exam separate testing area food and beverage during exam medication and water during exam ___ other: __________________________ ___ other: __________________________ 10C American LegalNet, Inc. www.FormsWorkflow.com 23. For each recommended accommodation other than additional time (which is covered in the following