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The form requires professional credentials, recent treatment/diagnosis details within the last five years, DSM-V diagnosis specifics for learning or psychological disabilities, and documentation with clinical/diagnostic data. Professionals describe impairment impact and recommend approved accommodations such as extra time, reader/recorder, and non-computerized paper-and-pencil exams. Candidates certify provided information and submit supporting materials via fax, email, or mail, with decision timing stated within five business days.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":20,"@type":76,"position":81},"https://docshare.wps.com/document/exam/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/special-accommodations-verification-request-form/442290/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/special-accommodations-verification-request-form/442290.png","ImageObject",300,407,{"name":92,"@type":93},"nayy☆","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":19},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Who is required to complete the Special Accommodations verification request form?","Question",{"text":112,"@type":113},"A licensed or otherwise qualified professional with appropriate credentials must complete the form. The professional must have treated and/or diagnosed the candidate within the last five (5) years and be familiar with the candidate’s current level of functioning.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What documentation must be enclosed to support learning disabilities?",{"text":117,"@type":113},"A copy of documentation dated within the last five (5) years must be enclosed, including diagnostic/clinical data and, for specific learning disabilities, copies of psychological or educational assessment reports with test results/evaluations confirming the diagnosis.",{"name":119,"@type":110,"acceptedAnswer":120},"How are accommodation request materials submitted and how quickly will a decision be made?",{"text":121,"@type":113},"Materials may be faxed to NMLS-Accommodations, emailed to NMLS_SARequest@Statemortgageregistry.com, or mailed to the listed NMLS – Accommodations address in Rockville, MD. Reasonable efforts will be made to render a decision within five (5) business days.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},442290,1790924079,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":19,"category_name":20,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":19,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39},962090893153,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","SPECIAL ACCOMMODATIONS  \nVERIFICATION REQUEST FORM  \nNMLS is committed to complying with the provisions of the Americans with Disabilities Act (ADA). Reasonable testing accommodations with modifications and aids will be provided to candidates with documented disabilities.  \nA Licensed or otherwise Qualified Professional whose credentials are appropriate to diagnose and evaluate the candidate’s physical or learning disability and make recommendations for appropriate test accommodations must complete this form. The professional must have treated and/or diagnosed the candidate within the last five (5) years and have knowledge of the candidate’s current level of function. Attach additional sheets as needed. A copy of the documentation, dated within the last five (5) years (e.g., educational assessment, psychological report) that provides diagnostic/clinical data (e.g., scores from educational testing) confirming the diagnosis, and the need for the testing accommodation must beenclosed with this form for all learning disabilities. If the last examination and/or report is over five (5) years old, please contact the NMLS Accommodations Team for additional guidance.  \nI: LICENSED/QUALIFIED PROFESSIONAL INFORMATION (To be completed by licensed or qualified professional)  \nLicensed/Qualified Professional’s Name:   Title:   License \\#:   License Granting Authority:   Institution/Practice Name:   Address:   City:   State:   Zip Code:   Country:   Daytime Telephone: ( )    \nII: CANDIDATE DISABILITY STATUS (Check all that apply)  \nPhysical   Learning   Hearing Impaired   Vision Impaired    \nOther (Specify):    \nIII: DIAGNOSIS AND TREATMENT INFORMATION  \nA. Specified Diagnosis:   \nPlease note: If this is a specific learning disability, learning-related or psychological disability, please provide identification of the DSM-V or the most current version of the DSM diagnosis. An individual self assessment is not acceptable. (Enclose copy of psychological or educational assessment report.)  \nB. Describe the manner in which this disability impairs major life activity/functioning:  \nC. Last date of your treatment or consultation with the candidate:  \nD. Identify the aspect(s) of the candidate’s functioning which requires testing accommodations, and the effect of the disability on the candidate’s functioning under standard testing conditions:  \nE. If the candidate has a specific learning or psychological disability, identify the specific assessments (e.g., standardized psychological/educational tests) used to identify and confirm the diagnosis. (You must enclose copies of these test results/evaluations/educational or psychological reports with this form or the request will not be considered.)  \nF. Please describe your qualifications/credentials and professional relationship with this candidate which facilitates making these recommendations for the candidate:  \nG. Based on your knowledge of this candidate’s disability and current functioning, which of the following accommodations are recommended? (Check all that apply) .  \nPaper & Pencil (Non-computerized) Exam ^   Extra Time**   Minutes  \nReader/Recorder^   Other: Please specify   \n^ Upon contacting the testing vendor, please be advised that they require 10 business days to prepare for appointments scheduled with these accommodations.  \nPlease allow 5 business days after testing for your paper exam to be scored and posted to your record.  \n* The standard testing time for the National Test is 190 minutes. If extra time is selected, the specific amount of extra time requested is required.  \nI certify that the information provided by me on this form is true and correct to the best of my knowledge.  \nProfessional’s Signature:   License/Certification Number:   Date:    \n*************************************************************************************  \nI,   , the Mortgage Loan Originator candidate, certify that all the information on this form is true and correct.  \nSignature:   Date:    \nNOTE: All f","cbCaiuLs4usuwX9K","https://ap.wps.com/l/cbCaiuLs4usuwX9K","pdf",51846,"English","# Verification Request Form\n## Licensed/Qualified Professional Information\n## Candidate Disability Status\n## Diagnosis and Treatment Information\n## Recommended Accommodations\n## Certification and Submission Instructions","[{\"question\":\"Who is required to complete the Special Accommodations verification request form?\",\"answer\":\"A licensed or otherwise qualified professional with appropriate credentials must complete the form. The professional must have treated and/or diagnosed the candidate within the last five (5) years and be familiar with the candidate’s current level of functioning.\"},{\"question\":\"What documentation must be enclosed to support learning disabilities?\",\"answer\":\"A copy of documentation dated within the last five (5) years must be enclosed, including diagnostic/clinical data and, for specific learning disabilities, copies of psychological or educational assessment reports with test results/evaluations confirming the diagnosis.\"},{\"question\":\"How are accommodation request materials submitted and how quickly will a decision be made?\",\"answer\":\"Materials may be faxed to NMLS-Accommodations, emailed to NMLS_SARequest@Statemortgageregistry.com, or mailed to the listed NMLS – Accommodations address in Rockville, MD. Reasonable efforts will be made to render a decision within five (5) business days.\"}]","Special Accommodations - Verification Request Form | PDF",1790699722]