Form N-648 - Medical Certification For Disability Exceptions - U.s. Department And Immigration Services Page 4

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Applicant's Name
USCIS A-Number
A-
9. What clinical methods did you use to diagnose the applicant's medical disability and/or impairments listed in number 1?
10. Clearly describe how the applicant's disability and/or impairments affect his or her ability to demonstrate knowledge and understanding
of English and/or civics.
11. In your professional medical opinion, does the applicant's disability or impairments prevent him or her from demonstrating the
following requirements? (Check all that apply. If none applies, the applicant is not eligible for this exception.)
The ability to:
Read English
Write English
Speak English
Answer questions regarding United States history and civics, even in a language the applicant understands.
Form N-648 03/21/17 Y Page 4

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