Special Accommodations Verification Request Form

D. Identify the aspect(s) of the candidate’s functioning which requires testing accommodations, and the

effect of the disability on the candidate’s functioning under standard testing conditions:

E. If the candidate has a specific learning or psychological disability, identify the specific assessments

(e.g., standardized psychological/educational tests) used to identify and confirm the diagnosis. (You

must enclose copies of these test results/evaluations/ educational or psychological reports

with this form or the request will not be considered.)

F. Please describe your qualifications/credentials and professional relationship with this candidate

which facilitates making these recommendations for the candidate:

G. Based on your knowledge of this candidate’s disability and current functioning, which of the following

accommodations are recommended? (Check all that apply).

Paper & Pencil (Non-computerized) Exam ^ _________

Extra Time** _________Minutes

Reader/Recorder^ _________

Other: Please specify______________________________________

^ Upon contacting the testing vendor, please be advised that the vendor requires 10 business days to

prepare for appointments scheduled with these accommodations.

For Paper & Pencil Exams, please allow 5 business days after testing for your paper exam to be

scored and posted to your WebCRD record.

* If extra time is selected, the specific amount of extra time requested is required. Please see the

attachment for the standard examination lengths.

I certify that the information provided by me on this form is true and correct to the best of my knowledge.

Professional’s Signature: ____________________________________ Date: ______________

License/Certification Number: _______________________________________

*************************************************************************************************************

I, ______________________________________, the candidate, certify that all the information on this

form is true and correct.

Signature: _______________________________ Date: ____________________

Note: All requests take approximately 2-3 business days to process after which a confirmation email will

be sent with the offered accommodations. All forms and supporting documentation may be faxed to

FINRA at (202) 303-3901 or emailed to .

If mailed, forms and documentation should be sent to the following address:

FINRA - Candidate Services

9509 Key West Avenue, 3rd Floor

Rockville, MD 20850

Personal Confidential Information

Special Accommodations Verification Request Form - Finra Page 2