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Accommodations Appeal Form

You may appeal an accommodations decision if any of your requested accommodations were not approved. Complete the information below and sign the release statement at the end of the section.

Appeal requests are generally more effective if they include:

A specific reason for appeal
Additional documentation beyond what was included with the original request

Make sure all sections are complete before submitting the form. Paradigm accommodations specialists will review your documentation and let you know if any additional information is required.

First Name:_________________________________________________

Last Name:__________________________________________________

Date of Birth:________________________________________________

Email:________________________________________________________

ID#___________________________________________________________

Phone Number:______________________________________________

Candidate’s Signature:_______________________________________

Date:__________________________________________________________

SECTION 1: REQUESTING TEST ACCOMMODATIONS: TO BE COMPLETED BY CANDIDATE

Part 1. Please indicate the testing accommodation(s) you are requesting:

_______• Extended Time: Standard Time + 25% (total: XX hours)
_______• Extended Time: Standard Time + 50% (total: XX hours)
_______• Additional 10-minute break per testing hour
_______• Scribe*
_______• Reader*
_______• Private room
_______• Other (specify):

*Note: These accommodations are automatically approved with a private room to prevent distractions to other test-takers. Please note that a scribe and/or reader are only approved in circumstances where the applicant is unable to read or write independently, even with extra time.

Part 2. Please explain your reason(s) for appealing. You may attach an additional sheet if necessary:

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________
Part 3: Additional supporting documentation: Please include any additional documentation you can provide to support this appeal.

Submit Your Appeal

The most secure method for submitting your confidential accommodations request materials is to upload them directly to Paradigm Testing’s secure SFTP Web site.

Please note that appeal decisions will be communicated to you within 30 days of receipt of the form.