Form 1 - Accommodation Request Candidate Form 1

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FORM 1 — ACCOMMODATION REQUEST — CANDIDATE FORM

CHARTERED PROFESSIONAL ACCOUNTANTS OF ONTARIO

If you have a disability and need to request testing accommodations for an examination, please complete

and return this form at least 10 weeks before the examination. Your accommodation request package must

include documentation of your disability provided by a qualified professional who is licensed or has

appropriate credentials to diagnose, treat, and recommend testing accommodations for individuals with your

disability. The documentation must be current, which in most cases means it was produced within the last

five years.

(Please print or type)

I. CANDIDATE’S INFORMATION

Name: ______________________________________________ Student #: ___________________

Address: ______________________________________________________________________________

City: _______________________ Province: ___________ Postal Code: ____________ Country: ________

Daytime Telephone Number (include area code): ______________________________________________

Examination Name and Date: ____________________________ Requested Centre:__________________

Repeater: Yes ________

No _________

I was accommodated in a previous CPA Ontario examination: Yes ____ Year(s) __________ No ____

II. DISABILITY STATUS (Check all that apply)

_________ Deaf

________ Hearing impaired

_________ Blind

________ Visually impaired

_________ Special learning/learning-related disability

________ Orthopaedic/physical disability

_________ Psychological/psychiatric/behavioural disability

_________ Other health disability/impairment Please specify ________________________________

III. DISABILITY AND TESTING ACCOMMODATIONS HISTORY

1. When was your disability professionally diagnosed?

___ less than 1 year ago

___ 1-2 years ago

___ 3-4 years ago

___ more than 5 years ago

2. In high school:

2.1 Did you attend a special school or program (special education) or have an individualized education

program?

____ Yes

____ No

2.2 Did you receive special accommodation for testing?

____ Yes

____ No

3. Did you receive special testing accommodations during your university undergraduate studies?

____ Yes

____ No

*If yes, please describe briefly __________________________________________________________

If yes, identify examination(s) and test date(s) _____________________________________________

Form 1 - Accommodation Request Candidate Form 1 - Pdf

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