Consent Form for Accommodations Request

SERVICES FOR STUDENTS WITH DISABILITIES

Consent Form for

Accommodations Request

By completing this form, you consent for College Board to process certain information

to inform decisions about accommodations provided to students on any College Board

tests that you choose to take, including SAT®, PSAT-related assessments, AP®, and CLEP®

as further detailed below.

Student Information:

Student Name

School:

Student Date of Birth:

Student and Parent/Guardian Signature:

I seek to apply for testing accommodation(s) on College Board test(s) that I may choose to take now or in the future,

including SAT, PSAT-related assessments, AP, and CLEP, due to disability. I authorize my school to release to College

Board copies of my records that document the existence of my disability and need for testing accommodations; to

release any other information in the school’s custody that College Board requests for the purpose of determining my

eligibility for testing accommodations on College Board tests; and to discuss my disability and accommodation needs

with College Board. I also grant College Board permission to receive and review my records and to discuss my disability

and needs with school personnel (including the school I attend and school at which the College Board test[s] may be

administered to me) and other professionals.

I understand and agree that any information and documentation my school may submit to support my request for

accommodations will be used by College Board to inform decisions about accommodations provided to me on any

College Board test(s) I choose to take, including SAT, PSAT-related assessments, AP, and CLEP. I understand that my

consent is necessary for College Board to collect, use, store, and analyze my mental or physical health condition

or diagnosis, including disability- or accommodations-related information, in order to make decisions about which

accommodations may be approved by College Board and to administer College Board test(s) to me with approved

accommodations.

I understand that I have the right to withdraw the above consent at any time by completing the Withdrawal of Consent

Form available at accommodations.collegeboard.org/request-accommodations/request/forms, and mailing or faxing

it to College Board at the address or facsimile number provided on the form.

Student Signature:

Parent/Guardian Signature:

(Parent/guardian signature is required if student is under 18.)

Date:

School Instructions

This form should be used when a request for accommodation(s) is submitted electronically (via SSD Online). The form

should be maintained by the school with the student’s records. It does not need to be sent to College Board. You will be

asked to verify that a signed consent form is on file at the school prior to submitting a request for accommodations.