FORM A

REASONABLE TESTING ACCOMMODTIONS
All required forms and evaluations MUST be submitted
at the time your application for admission is filed. There are no exceptions to this requirement.

QUESTONNAIRE

(To be completed by all applicants who request reasonable testing accommodations)

NOTE: This form is part of the Application for Admission to the New Mexico State Bar. The applicant is responsible for completeness and accuracy of the information provided. If you are requesting a reasonable test accommodation, this form must be completed and returned with your Application for Admission.

(Please type or print legibly)

Applicant Name: _______________________________________________________

Social Security Number: _________________________________________________

Address: _____________________________________________________________

_____________________________________________________________________

Phone Number: ______________________ Exam Date: ________________________

___ Blind

___ Visually impaired

___ Hearing impaired

___ Other physical disability

___ Psychological disability

___ Specific learning disability

My condition is: _________________________________________________________

Describe the nature and extent of your disability: _______________________________

_______________________________________________________________________

_______________________________________________________________________

How long have you had your disability? ______________________________________

Past Accommodations Granted: YES NO

Were you in a specific school or program to accommodate your

disability? ____ ____

Did you receive accommodations for classroom tests? ____ ____

Did you receive additional testing time for classroom tests? ____ ____

Were you granted testing accommodations for taking the

LSAT or MPRE? ____ ____

Were you granted accommodations for another state’s bar exam? ____ ____

If yes, list the state, date and accommodations received:_________________________

_______________________________________________________________________

Please describe the accommodations you were given during law school, at the MPRE or LSAT, or other bar exam:__________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Please describe any additional accommodations you were granted while in college and/or law school:_________________________________________________________________

_______________________________________________________________________

Requested Accommodations (check all that apply):

___ Braille version of test

___ Large print test book ___ 18 point ___ 24 point

___ Audio cassette version of test

___ Use of tape recorder

___ Use of reader

___ Use of transcriber

___ Other:_______________________________________________________________

________________________________________________________________________

___ Additional testing time. Please specify amount of additional time for each part of the exam.

Written exam (essay and multistate performance test questions): ________________________________________________________________________

Multistate exam:___________________________________________________________

I understand that the information on this form is true and correct and that it may be reviewed by a physician or licensed professional.

____________________________________
Signature

____________________________________
Date