Accommodation form
Email address *
FirstName
LastName
Email address used to register at Pearson
Confirm Email address
Birthday
MM
/
DD
/
YYYY
Street Address:
Street Address 2:
Country
State/Province/Region
City
Zip/Postal Code
Phone
Extension
Please click here if you are under 18 years or have a legal guardian:
Indicate the name of the exam for which you are requesting reasonable adjustments (please be specific)
Disability Category *
Required
Request Item *
Required
Request Rationale *
Additional person(s) you permit Unity Accommodations team to discuss/contact on your behalf regarding this request. This is not a required step. Please enter Name, email, relationship and phone for each person.
Supporting Documentation
How long ago was your Documentation completed? Please keep in mind that for Psychological disorders, Psychiatric disorders, Physical disorders and Chronic Health conditions, we want the documentation to be completed in the last 1 year. For ADHD, we want the documentation to be completed in the last 3 years. For Intellectual disabilities, Learning and Other Cognitive disabilities, we want the documentation to be completed in the last 5 years.
Was the documentation completed by a professional qualified to diagnose your condition?
Does your documentation contain a clear diagnosis and discuss the impacts of the disability on your performance?
Please feel free to share any other information you have that may help support and expedite your accommodation request.
Submit
Never submit passwords through Google Forms.
This form was created inside of Unity Technologies. - Terms of Service - Additional Terms