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The form collects applicant identity, requested exam timing, exam name and technology, and captures whether special accommodation is needed. A professional assessor supplies required accommodation details such as extra time, separate exam room, or an exam reader, including condition identification and additional time amounts. 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Any personal information collected is handled in accordance with the British Columbia Freedom of Information and Protection of Privacy Act. If you have questions about the collection, use, or disclosure of this information, contact the Records, Information and Privacy Analyst for the Technical Safety BC at 1 866 566 7233.  \nInstructions: This form must be completed and submitted with the application for examination at least 3 weeks before the requested exam date. If an exam reader is requested, the exam reader must complete Schedule A: Exam Reader Application on page 3.  \nA. Applicant Information (To be completed by the applicant):  \n\n| Legal\u003Cbr>First Name: |  | Legal\u003Cbr>Last Name: |  | Phone number: |  |\n| --- | --- | --- | --- | --- | --- |\n| Email Address: |  |  |  | Birth Month and Year: |  |\n| Requested Exam Month: | Select   |  | Exam Name: |  | Exam Duration: |\n| Exam Technology: Select. .. |  |  |  |  |  |\n\nB. Professional Assessor Information (To be completed by the professional assessor):  \n\n| A professional assessor is a licensed physician, education psychologist, learning disability specialist, disability service advisor ora trained staff employed by a learning disability resource centre at a public high school or post-secondary institution. |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| Professional Name: |  | Professional Title: |  |  |\n| Organization Name: (Professional Institution or Facility) |  |  |  |  |\n| Organization Address |  |  |  |  |\n| Unit/\u003Cbr>Suite No: | Civic No: | Street Name: |  | Street Type: |\n| City: |  | Province: | Postal Code: |  |\n| Email Address: |  | Phone number: |  |  |\n\nC. Accommodation Information (To be completed by the professional assessor):  \n\n| Special accommodation required |  |  |\n| --- | --- | --- |\n|  |  | Exam reader (please complete page 3)\u003Cbr>Identify the condition or disability:   Extra time\u003Cbr>Identify the condition or disability  Amount of additional time required   min\u003Cbr>Separate exam room Other (please specify): |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n|  |  |  |\n\nContinue to page 2 for professional assessor and applicant declaration  \nD. Professional Assessor Declaration (To be completed by the professional assessor):  \n\n|  |  | I certify that the information I have provided is accurate and I understand and agree that Technical Safety BC reserves the right to verify the accuracy of this information.\u003Cbr>I understand that I may be required to provide a further assessment of the applicant’s ability to perform safety critical work and the results of this assessment may result in terms & conditions being applied to the applicant’s certificate of qualification. |  |\n| --- | --- | --- | --- |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n| Professional Signature: |  |  | Date: |\n\nE. Applicant Declaration (To be completed by the applicant):  \n\n|  |  | I understand that if I pass the examination and meet all other certification requirements, Technical Safety BC will consider whether my medical condition or learning disability could impact my ability to perform regulated work safely. I understand that a further assessment by a medical practitioner or other occupational assessment expert may be conducted to determine my ability to perform safety critical work , and terms & conditions may be added to my certificate of qualification.\u003Cbr>I authorize the professional above to provide the information in this form for the purpose of an accommodation request with Technical Safety BC. I authorize the release of this completed form to Technical Safety BC to review and process my special accommodation request.\u003Cbr>I","cbCaihwbqP0VRY8U","https://ap.wps.com/l/cbCaihwbqP0VRY8U","pdf",144682,"English","# Applicant Information\n# Professional Assessor Information\n# Accommodation Information\n# Professional Assessor Declaration\n# Applicant Declaration\n# Schedule A: Exam Reader Application","[{\"question\":\"Who must complete the form and which sections do they fill out?\",\"answer\":\"The applicant completes Applicant Information and the Applicant Declaration. A professional assessor completes Professional Assessor Information, Accommodation Information, and the Professional Assessor Declaration. Schedule A is completed only when an exam reader is requested.\"},{\"question\":\"How far in advance must the form be submitted for an exam accommodation request?\",\"answer\":\"The form must be completed and submitted with the examination application at least 3 weeks before the requested exam date.\"},{\"question\":\"What accommodation details can a professional assessor request?\",\"answer\":\"The assessor can indicate special accommodation requirements such as an exam reader, extra time (including the amount of additional time in minutes), a separate exam room, or other specified accommodations with the relevant condition or disability identified.\"}]","EXAM SPECIAL ACCOMMODATION REQUEST FORM - Instructions and Declaration | PDF"]