Request For Accommodation Of Disabilities Form printable pdf download

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.

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.)

____________________________________________________________________________________________________

Describe the accommodation requested. (Attach additional pages if necessary.)

____________________________________________________________________________________________________

______________________________________________________________________________________________________

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.)

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.

Request For Accommodation Of Disabilities Form