Ged Test Accom App Adhd

8/8/2019 Ged Test Accom App Adhd

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Checklist for Completing

Attention-Deficit/Hyperactivity Disorder

Testing Accommodations Request Form(s)

This checklist can be used to assist you, the GED testing candidate (or an advocate acting on behalf of the candidate), and the Chief Exami

at your local GED Testing Center with instructions on how to properly complete the GED Testing Accommodations Request form.You do not need to submit this form with your request for accommodations.

Candidate Last Name: _________________________________ Candidate First Name: ____________________________________

Candidate Social Security or Social Insurance Number: ________-_____-________

Be sure to ask the Chief Examiner at your local GED Testing Center any questions you may have about any part of the documentation/requprocess that you do not understand.

•As of 09/01/05, The GED Testing Office no longer accepts forms L-15 or SA-001. Please obtain the appropriate disability form from ylocal GED Testing Center or online at http://www.emsc.nysed.gov/ged/mods.shtml. The approved forms are: 1) Learning and CognDisabilities, 2) Attention-Deficit/Hyperactivity Disorder, 3) Emotional/Mental Health, and 4) Physical/Chronic Health Disability.

•Complete the GED candidate section (Section One) at the top of the request for accommodation form(s), providing completeand accurate information in all areas of this section.

•Be sure to sign the candidate signature line of the request for accommodation form(s). If you are under the age of 18, a parent or

guardian must also sign.

•Be sure the professional diagnostician or advocate has completed all of the appropriate sections. Your advocate may assist

you by providing information from your medical and/or educational records onto your request for accommodations form(s). The

advocate can also sign on Section Three as long as the name of the professional diagnostician is listed .

•Letters are required from the specialist making the diagnosis . For Physical/Chronic Health and Emotional /Mental Health

accommodation requests, the letter must be less than 6 months old ; for ADHD form, the letter must be less than 3 years old . Th

letter must be on official letterhead and signed by the specialist making the diagnosis.

•Return your completed request for accommodations form(s) and all supporting documentation to the GED Chief Examine

the testing center where you will take your test.

•Provide the professional diagnostician, advocate or candidate with the appropriate accommodation request form , which candownloaded from http://www.emsc.nysed.gov/ged/mods.shtml.

•To assist with the application process, provide the candidate and/or advocate with all relevant resources (e.g., information on howcomplete the form, test schedules for your test center, brochures/pamphlets, etc.).

•TheChief Examiner must complete and sign Section Two before it is submitted to the GED Testing Office for review. The Chief Examiner must review the entire form to ensure all information is complete and all relevant supporting documentation is attached .

If the Application Request has not been completed by the candidate, advocate, and/or diagnostician:

• Return application to professional diagnostician, advocate or candidate for additional information/documentation.Provide the professional diagnostician, advocate or candidate with specific written directions for properlycompleting the forms, including:

Date returned: ___________________

Items needed to complete the forms:____________________________________________________________

When the request has been completed, mail the entire application to the NYSED GED Administrator. Date sent: _______________

http://www.emsc.nysed.gov/ged/mods.shtml










Last Name: _____________________________________________ First Name: ___________________________________

ocial Security or Social Insurance Number: ______-_____-_______ Birth Date: ____/____/________ Age: ____________

Address: ________________________________________________

City: ___________________________ State: ______________ Zip/Postal Code: _______________________________

Phone Number: ( ) -

Release of Information: If you are under 18 years of age, your parent or guardians signature is also required.

grant permission to school officials and my healthcare provider(s) to release my education-related records and/or my medical or psycholo

ecords to the GED Testing Service and its designees in connection with my request for testing accommodations.

Chief Examiner Name: __________________________________ 3 Digit SED Center Code: ________________________

Center Name: _________________________________________ 10 Digit GEDTS Center ID# ______________________

Phone Number: ( ) - Fax Number: ( ) - Email Address:

have reviewed this application and confirm that it is complete.

Please indicate your role: Professional Diagnostician Advocate

Name of Professional Making Diagnosis (please print): _________________________________________________________________

Phone Number: ( ) - Date of Assessment: ____/____/__________________________

Licensure or Certification: ______________________________ Expiration Date: ____/____/_____________________________

tate/Province: ___________ Number:________________ Specialty:____________________________________________

Name of Advocate (please print): __________________________________________________________________________________

Relationship to Candidate (please print): __________________________________Phone Number: ( ) -

Professional Making Diagnosis or Advocate’s Signature: _____________________________________Date: ______________________

ADD/ADHD- Page 1 of 4



Request for Testing Accommodations


Supporting documentation on professional diagnostician’s letterhead attached. (Required.)

DSM-IV Diagnosis Code: Indicate all that apply.

314.01 Attention Deficit/Hyperactivity Disorder, Combined Type

314.00 Attention Deficit/Hyperactivity Disorder, Predominantly Innattentive Type

314.01 Attention Deficit/Hyperactivity Disorder, Predominately Hyperactive/Impulse Type

314.9 Attention Deficit/Hyperactivity Disorder, Not Otherwise Specified

Functional Limitation(s):

______________________________________________________________________________________________

______________________________________________________________________________________________

Recommended Accommodation(s): ______________________________________________________________________________________________

______________________________________________________________________________________________

Rationale for Accommodation(s):

_______________________________________________________________________________________ ______

______________________________________________________________________________

ADD/ADHD- page 2 of 4



Request for Testing Accommodations


Extended Time (please specify): 1 ½ times 2 times Other:_____________________________________

Audiocassette (tone-indexed) (requires extended testing time, generally double time)

2 times Other: ____________

The use of this accommodation requires practice. Candidates should have an opportunity to practice using an Official G Practice Test, Audiocassette Version prior to the scheduled testing date.

Braille

Scribe

Calculator for Part II

Talking Calculator for entire mathematics test.

Private room

Supervised Breaks (specify in minutes):

Uninterrupted testing time:________ minutes, break time:________ minutes

Other_ _______________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____

General Educational Development (GED) Testing Service will not discriminate against candidates for testing on the basis of any legally

rotected characteristic, including, but not limited to, race, color, religion, sex, sexual orientation, pregnancy, marital status, physical or me

isability, age, veteran status, and national origin.

ADD/ADHD – page 3 of 4



Approved for:

Extended Time (please specify): 1 ½ times 2 times Other: ________

Audiocassette (tone indexed) (requires extended testing time, generally double time)

2 times Other: ________

The use of this accommodation requires practice. Candidates should have an opportunity to practice using an

Official GED Practice Test, Audiocassette Version prior to the scheduled testing date.

Braille

Scribe

Calculator for Mathematics part II

Talking calculator for entire Mathematics Test

Private Room

Supervised Breaks (specify in minutes):

Uninterrupted testing time:________ minutes, breaks time:________ minutes

Other__________________________________ __________________________________ _______________

Returned for more information. Date Returned: ____/____/________

Reasons for returning request:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Request forwarded to GEDTS for review (explain reasons below) Date Forwarded: ____/____/________

Reasons for forwarding request to GEDTS for review:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_____________________________ _(518) 474-2801___ __________________

GED Administrator's Signature Telephone Number Date

ADD/ADHD page 4 of 4



Documents

Ged Test Accom App Adhd