Request For Accommodation Of Disabilities Form

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WYOMING BOARD OF CERTIFIED PUBLIC ACCOUNTANTS
2020 Carey Avenue, Suite 100
Cheyenne, WY 82001
(303) 777-7551 FAX (303) 777-3796
REQUEST FOR ACCOMMODATION OF DISABILITIES
TO BE COMPLETED BY THE CANDIDATE
If you have a disability or medical condition, and you wish to request an accommodation for the CPA exam, please provide the following
information and return this form along with the evaluator’s form with your examination application. This form and other documentation will
become a part of your examination record, but will be purged from your file when you have passed the examination.
1.
What is the type of disability that limits one or more of your major life activities (e.g., physical, mental, learning) and the nature and
extent of the disability. (Attach additional pages if necessary.)
____________________________________________________________________________________________________
2.
Describe the accommodation requested. (Attach additional pages if necessary.)
____________________________________________________________________________________________________
______________________________________________________________________________________________________
3.
Provide the Board with verification of your disability from a qualified professional supporting your requested accommodation(s) (see
attached form). The Board will not pay any costs you may incur in obtaining the required documentation. However, we will pay for
any reasonable accommodations that are made for you. This information is considered confidential and will not be released. (Attach
additional pages of necessary.)
4.
Provide a history of prior accommodations granted by professors, teachers or others. (Attach additional pages if necessary.)
___________________________________________________________________________________________________
Upon receipt of this information, the request will be considered and you will be notified in writing of the Board’s decision. If you have any
questions you may contact the Executive Director at (307) 777-7551.
NAME ______________________________________________
DATE ______________________________________________
This form must be submitted with the CPA exam application prior to the deadline date outlined in the rules..
BOARD USE ONLY
Examination/Accommodation History
ACCOMMODATIONS:
______________________________________________________________________________________
EXAM DATES:
_______________________________
________________________________
_______________________________
________________________________
_______________________________
________________________________
NOTE: The information provided will be used to determine the appropriate accommodation. Failure to provide this information will result
in denial of the request. Applicants have the right to review their records subject to the provisions of the Public Records Act.

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