FORM C

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

SUPPLEMENTAL DOCUMENTATION FOR LEARNING DISABILITIES

(To be completed by a licensed professional)

An applicant with a specific learning disability must have been identified by a psycho-educational assessment process which includes data from both cognitive and achievement measures listed below. Testing must also:

1. have been administered within the last three years;
2. identify an information processing deficit;
3. certify that the applicant’s apptitude is within the normal range;
4. identify an aptitude-achievement discrepancy of 1.5 standard deviations.

(Please type or print legibly)

Name (Licensed Professional):______________________________________________

Name (Applicant):________________________________________________________

Nature and extent of impairment: ____________________________________________

_______________________________________________________________________

Summary of diagnosis:____________________________________________________

_______________________________________________________________________

What tests were used to identify the learning disabilities? Include the date the test was completed.

1._____________________________________________________________________

2._____________________________________________________________________

3._____________________________________________________________________

4._____________________________________________________________________

5._____________________________________________________________________

How will this condition be ameliorated by the recommended test accommodation?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

I certify that all the information on this form and that attached hereto is true and correct to the best of my knowledge and belief. I understand this information may be reviewed by a physician or licensed professional retained by the New Mexico Board of Bar Examiners to assist in determining reasonable testing accommodations.