EIPA Testing Accommodations Request

EIPA Testing Accommodations Request

Requests must be approved before registering for a test.
Interpreters requesting reasonable accommodations because of disabilities must provide appropriate documentation of the disability and specify the extent to which the standard testing procedures need to be modified. This documentation must be submittted before registering for a test. Approval for test accommodations can only be granted by the EIPA Diagnostic Center. Test administrators do not have the authority to approve accommodation requests.

To request accommodations, interpreters must submit the following documentation to the EIPA Diagnostic Center:
1. The EIPA Testing Accommodation Request form (this form)
2. Formal documentation from a qualified/licensed professional or testing professional who has conducted testing or provided treatment for the disability or diagnosis. (This documentation can be uploaded and attached to this form.) The documentation must be sent on official letterhead and include:
  1. A statement of the specific disability or diagnosis
  2. A description of the disability and why accommodations are needed
  3. Tests or protocols used to confirm diagnosis
  4. A description of test accommodations prescribed for the disability
  5. The diagnosing professional's signature, their title, and contact information
First Name*
Last Name*
Email*

Confirmation Emailexample@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
I am requesting accommodation(s) for the following test:*

EIPA Written TestEIPA Performance Test
Have you already registered for a test?

YesNo
If you already registered, what is the date and time of the test?

MonthDayYear
DateHourMinutesAM/PM Option
Name of the diagnosed disability.*
Please describe the accommodation(s) you are requesting. Please be specific. :*
Attach the required documentation from a qualified/licensed professional or testing professional who has conducted testing or provided treatment for the disability or diagnosis. *

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The documentation must be sent on official letterhead and include: 1) A statement of the specific disability or diagnosis. 2) A description of the disability and why accommodations are needed. 3) Tests or protocols used to confirm diagnosis. 4)A description of test accommodations prescribed for the disability. 5) The diagnosing professional's signature, their title, and contact information. Cancelof
Additional documentation (optional)

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Additional documentation (optional)

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Should be Empty: