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NST FORM 1: PETITION FOR TEST ACCOMMODATIONS
This petition should be used by: applicants requesting test accommodations on the bar examination for
the first time; applicants who were denied accommodations on a prior examination; applicants for re-
examination who did not previously request accommodations; and applicants who were granted
accommodations in the past but who have not taken the examination in the last three (3) years. To be
timely, this application must be received in the CBEC Administrative office by the application deadline.
This is NOT a “postmarked by” deadline.
I. GENERAL INFORMATION
1. Name: _________________________________________________________________
Last First Middle
2. Address where you may be contacted concerning this application:
________________________________________________________________________
Number and Street Address or P.O. Box Number
________________________________________________________________________
City State/Province Zip/Postal Code
____________________ ____________________________________________
Daytime Telephone Number E-mail address
3. Examination: ___________
II. DISABILITY STATUS
4. Check the disability or disabilities for which you are requesting accommodations.
Learning disability
AD/HD
Physical disability
Visual impairment
Hearing impairment
Psychological disability
Other (describe) ____________
5. List your age when first diagnosed. ______________
III. HISTORY OF ACCOMMODATIONS
For questions 6 through 11 below, please follow these instructions:
If you were granted accommodations, check “Yes.” List the condition or diagnosis for which
accommodations were granted, the specific accommodations granted, the educational institution or
testing agency that granted the accommodations, and the time frames when the accommodations were
granted (i.e. senior year only, all years, etc.).
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If you did not request accommodations, check “Not requested.” Explain why you did not request
accommodations.
If you were denied accommodations, in whole or in part, check “Denied.” List the month and year the
request was made, the condition or diagnosis for which accommodations were requested, the
accommodations requested, the educational institution or testing agency, the reason given by the entity
for the denial, and provide the denial letter from the institution. Note: if your request for accommodations
was granted in part and denied in part, you should check both “Yes” and “Denied.”
If you did not attend the type of school or take that exam, check “N/A.”
6. Did you receive accommodations in law school?
Yes Not requested Denied N/A
7. Did you receive accommodations in college (undergraduate or graduate studies)?
Yes Not requested Denied N/A
8. Did you receive accommodations or disabled-student services in high school, including but not
limited to accommodations or services provided as a result of an Individualized Education Plan (IEP)
or a 504 Plan?
Yes Not requested Denied N/A
9. Did you receive accommodations or disabled-student services in elementary or middle school,
including but not limited to accommodations or services provided as a result of an IEP or a 504 Plan?
Yes Not requested Denied N/A
_____________________________________________________________________
_____________________________________________________________________
__ ______________________________________________________________
_____
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10. Did you receive accommodations for any of the following standardized tests:
LSAT Yes Not requested Denied N/A
MPRE Yes Not requested Denied N/A
MCAT Yes Not requested Denied N/A
GRE Yes Not requested Denied N/A
GMAT Yes Not requested Denied N/A
SAT Yes Not requested Denied N/A
ACT Yes Not requested Denied N/A
11. Have you ever requested accommodations on the bar examination in any jurisdiction other than
Connecticut or are you requesting accommodations on a concurrent bar examination in a jurisdiction
other than Connecticut? List each jurisdiction in which you have made such a request and submit a
completed NST Form 7: Certification of Accommodations History from each such jurisdiction.
Yes Not requested Denied N/A
IV. ACCOMMODATIONS REQUESTED FOR THE CONNECTICUT BAR EXAMINATION
(CHECK ALL THAT APPLY)
MPT/MEE EXAMINATION
Test question formats:
Regular
Braille
Audio CD
Microsoft Word document on data CD for use with screen-reading software
Large print/18-point font
Large print/24-point font
Assistance:
Reader
Typist/Transcriber for MPT/MEE
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Extra testing time. Indicate below how much extra testing time is requested for each session:
Test Portion
Standard Time
Extra Time Requested (25%, 50%, or 100%
of the standard time)
MPT
AM – 2 performance tests –
3 hours
MEE
PM – 6 essays - 3 hours
Extra breaks. Describe the duration and frequency of the requested breaks.
Other arrangements (e.g., elevated table, limited testing time per day, lamp, medication, etc.). Describe
the arrangements.
For each accommodation you are requesting, explain why the accommodation is necessary and how it
alleviates the impact of your disability or disabilities in the context of taking the bar examination.
MULTISTATE BAR EXAMINATION
Test question formats:
Regular
Braille
Audio CD
Large print/18-point font
Large print/24-point font
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Assistance:
Reader
Scribe for MBE
Extra testing time. Indicate below how much extra testing time is requested for each session:
Test Portion
Standard Time
Extra Time Requested (25%, 50%, or
100% of the standard time)
MBE
AM – 100 multiple choice - 3 hours
MBE
PM – 100 multiple choice– 3 hours
Extra breaks. Describe the duration and frequency of the requested breaks.
Other arrangements (e.g., elevated table, limited testing time per day, lamp, medication, etc.). Describe
the arrangements.
For each accommodation you are requesting, explain why the accommodation is necessary and how it
alleviates the impact of your disability or disabilities in the context of taking the bar examination.
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V. SUPPORTING DOCUMENTATION
Requests for test accommodations must be supported by the following documentation from third parties,
which you must provide with your completed NST Form 1: Applicant Request for Test Accommodations.
Review the General Information on the CBEC website for a detailed explanation of the
supporting documentation you should submit.
Applicable Verification Forms and Medical Documentation
Submit the applicable disability verification form and supporting medical documentation from a qualified
professional who conducted an individualized assessment and who gave the diagnosis which forms the
basis for the request for test accommodations. If you are requesting accommodations based upon more
than one disability, you should supply medical documentation to support each disability.
Verification of Accommodations History
Provide verifying documentation of your accommodations history, if any. Submit a NST Form 7:
Certification of Accommodations History completed by each educational institution or testing agency
(hereinafter “entity”) from which you requested accommodations in the past, whether granted or denied.
Alternatively, you may provide other proof of your accommodations history, such as a copy of the letter(s)
you received from the entity notifying you of the specific accommodations granted or denied. The proof
should identify the time frame (e.g., third year of law school) and the nature of the disability (e.g.,
AD/HD) for which any accommodations were granted or denied. If you received accommodations as a
result of an Individualized Education Plan (IEP) or a 504 Plan, please provide copies of all IEPs or 504
Plans.
Academic Transcripts and Test Scores
Transcripts or report cards from elementary, middle, junior high, high school, college and law school
should be provided, along with standardized test scores, such as SAT/ACT and LSAT. Photocopies are
permitted.
VI. APPLICANT CHECKLIST
Review this checklist carefully and checkmark the appropriate lines to indicate the documents you are
submitting to request accommodations for the Connecticut Bar Examination. Submit this completed
checklist with your request. Review carefully the General Instructions on the CBEC website,
particularly the section “Submitting a Complete Request.”
1. The applicable disability verification form with comprehensive evaluation report and/or
relevant records attached. The burden of providing this documentation is on the applicant
requesting accommodations.
____ NST Form 2: Learning Disability Verification (comprehensive evaluation report and/or relevant
records MUST be attached)
____ NST Form 3: Attention Deficit/Hyperactivity Disorder Verification (comprehensive evaluation
report and/or relevant records MUST be attached)
____ NST Form 4: Psychological Disability Verification (comprehensive evaluation report and/or
relevant records MUST be attached)
____ NST Form 5: Visual Disability Verification (relevant test results MUST be attached)
____ NST Form 6: Physical Disability Verification (comprehensive evaluation report and/or relevant
records MUST be attached)
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2. An NST Form 7: Certification of Accommodations History completed by each entity from
which you previously requested accommodations and/or a copy of notification letters
____ Not applicable (if you have never requested accommodations before)
____ Bar examining agency in another jurisdiction
____ Law school
____ Undergraduate or graduate studies
____ Standardized tests (LSAT, MPRE, MCAT, GRE, GMAT, SAT, ACT)
____ Individualized Education Plan (IEP) or 504 Plan
____ High school (other than IEP or 504 Plan)
____ Elementary or middle school (other than IEP or 504 Plan)
3. Academic Transcripts and Test Scores
____ Elementary, middle, high school, college, and law school transcripts (photocopies permitted)
____ Test scores – such as SAT/ACT and LSAT (photocopies permitted)
____ Explanation as to why transcripts and/or test scores are not provided
4. Authorization and Release
____ Signed and Notarized authorization and release form
5. Petition form
____ Completed and signed NST Form 1: Petition for Test Accommodations
____ Personal narrative - Optional
____ This completed checklist
I have completed and attached all the required forms and supporting documentation.
___________________________________________ __________________
Applicant signature Date signed
If you are unable to sign this form, please have someone sign and date in your presence.
___________________________________________ ___________________
Signature of individual signing on behalf of applicant Date signed
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VII. CERTIFICATION THAT INFORMATION SUPPLIED IS TRUE AND COMPLETE
_____ Initial I declare under penalty of perjury that the foregoing statements are true and correct to
the best of my knowledge and that the information I have provided in support of my
request for test accommodations is true and complete.
_____ Initial I understand that if the Committee determines that I, or a third party on my behalf,
submitted as part of this request any information or documentation that is false,
inaccurate, or intentionally misleading, the Committee reserves the right to treat such
conduct as a character and fitness issue, pursuant to Article VI-14 (a) (3) of the CBEC
Regulations.
_____Initial I understand that both my request for test accommodations and all supporting
documentation may be submitted for evaluation to one or more qualified professionals
retained by the Committee, and I authorize such disclosure.
_____ Initial I understand that all necessary documentation and information must be provided to the
CBEC by the deadline and that my application for test accommodations will be
administratively rejected if it is found to be incomplete, untimely, or otherwise not filed
in compliance with the Committee’s instructions.
___________________________________________ ______________________
Applicant signature Date signed
If you are unable to sign this form, please have someone sign and date in your presence.
___________________________________________ ______________________
Signature of individual signing on behalf of applicant Date signed
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