ACCOMMODATION REQUEST FORM

 

Request for special accommodations must be made via this form only. Requests by telephone, email, or fax will not be accepted. The CELBAN Centre grants special accommodations to test takers who have a documented physical or mental disability that requires alternative testing arrangements. Your test date and time may change, depending on the required accommodations. Before you complete this form, please review our Policies & Procedures.

  1. If you would like to request special accommodations during your test, please complete and submit the form below.
  2. Please attach all necessary supporting documentation from a healthcare or counselling professional which indicates a diagnosis and describes your current limitation.
  1. After submitting the form, you will receive an email confirming your request.
  2. We will contact you again, after we have assessed your submission. Please allow up to 20 business days. To avoid delays, please submit the form only once and ensure all your information is correct.
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TEST LOCATION

  
TEST DATE
dd/mm/yyyy
TEST TAKER INFORMATION

  
  
  
dd/mm/yyyy
 
  
  
TEST TAKER ADDRESS AND PHONE NUMBER





 
 
PLEASE DESCRIBE THE REASON FOR YOUR REQUEST

Statement of the nature of the disability and its severity:

PLEASE DESCRIBE THE TYPE OF ACCOMMODATION REQUIRED

A clear and concise description of the special accommodation(s) requested:
SUPPORTING DOCUMENTATION

Please upload at least one supporting document from a healthcare or counselling professional which indicates a diagnosis and describes your current limitation.
 
MS Word document, PDF, and graphic files are acceptable.