GED® Computer Based Test
REQUEST FOR TESTING ACCOMMODATIONS
LEARNING AND OTHER COGNITIVE DISABILITIES
SECTION ONE: TO BE COMPLETED BY THE GED ® TEST TAKER
Test candidates must complete all information and sign the release statement at the end of Section 1. A professional evaluator or
advocate must complete sections 2 and 3, with section 4 being worked on together with the test-taker. Once the form is completed, follow
the directions as noted on the last page of this request form and/or in your account creation emails (www.GEDcomputer.com). It is highly
recommended that a GED instructor, examiner, advocate, etc. review your accommodations request before submitting for review. Please
note that once your accommodation request is received by GED Testing Service ®, allow up to thirty days before receiving a
call/email of the accommodation decision.
Test-Taker Name:
GED Testing Service
Registration ID # :
Date of Birth:
Age:
MM
Located on the Online Registration System
DD
YYYY
Address:
STREET (NUMBER AND NAME)
APARTMENT NUMBER
CITY
P.O. BOX
STATE PROVINCE/TERRITORY
Phone Number:
ZIP/POSTAL CODE
Email Address:
Have you previously been approved for accommodations on the GED test? ____Yes ____ No
If yes, in what state/jurisdiction and when were you approved?
_____
STATE/JURISDICTION
MM/YYYY
Release of Information: I grant permission to school officials and my healthcare provider(s) to release my education-related records
and/or my medical or psychological records to GED Testing Service and its designees in connection with my request for testing
accommodations. if you are under 18, a parent or guardian must also sign.
Test-Taker’s Signature:
Date:
Parent/Guardian’s Name (under 18):
Additional person (s) you permit GED Testing Service ® to discuss/contact on your behalf regarding this request (i.e. family
members, case workers, doctors, advocates, etc.).
Name: ________________
Name: ______________
Relationship to Test-Taker:
Relationship to Test-Taker:
Phone Number:
Phone Number:
Email:
Email:
Candidate Signature: __________________________________________________________ Date: ____________________________
LCD CBT Request
Form
Page 1 of 7
GED® is a registered trademark of the American Council on Education and may not be used or reproduced without express written permission.
September 2012
GED® Computer Based Test
REQUEST FOR TESTING ACCOMMODATIONS
LEARNING AND OTHER COGNITIVE DISABILITIES
SECTION TWO: TO BE COMPLETED BY THE
PROFESSIONAL DIAGNOSTICIAN OR ADVOCATE
The professional diagnostician or the advocate may complete this section. Supporting documentation must be attached to this
request form. Documentation and assessment tests must include a clear diagnosis and provide information on current functional
limitations that might affect the test-taker’s ability to take the GED® Tests under standard conditions. Documentation is current if the
assessment and testing was completed within the last five (5) years.
The documentation must:
1)
2)
3)
4)
Include a clear diagnosis
Include results from specific objective tests of intelligence and academic achievement (acceptable tests listed below)
Document the history of impairment
Confirm that the underachievement is not due to other disorders (such as an emotional disorder or a physical disorder), or
English-as-a-second-language (ESL) factors
5) Provide information on current functional limitations that are likely to affect the test-taker’s ability to take the GED® Tests
under standard conditions
6) Provide a specific rationale for each requested accommodation
Name of Diagnosing Professional:
Highest Degree and Area of Specialization:
License Number:
Expiration Date:
Phone Number:
_____
Issuing State/Province/Territory:
AREA CODE
E-mail Address:
Diagnosing Professional’s Signature:
Date:
*An advocate is someone other than the professional diagnostician, like a teacher, nurse, or therapist, who helps the test-taker complete
the forms. If you are the advocate, transfer the above information from the documentation and provide your information below.
Name of Advocate:
Relationship to Test-Taker:
Phone Number:
AREA CODE
Advocate’s Signature:
LCD CBT Request
Form
Date:
Page 1 of 7
GED® is a registered trademark of the American Council on Education and may not be used or reproduced without express written permission.
September 2012
GED® Computer Based Test
REQUEST FOR TESTING ACCOMMODATIONS
LEARNING AND OTHER COGNITIVE DISABILITIES
SECTION THREE: TO BE COMPLETED BY THE
PROFESSIONAL DIAGNOSTICIAN OR ADVOCATE
MEASURES OF INTELLIGENCE
Only one (1) complete measure is required. Indicate the date that the assessment was administered.
Note: IQ screening measures (e.g., WASI, K-BIT, etc.) and older editions of the WAIS are NOT acceptable.
Acceptable Measures of Intelligence
 Wechsler Adult Intelligence Scale IV- (WAIS-IV)
 Wechsler Adult Intelligence Scale III (WAIS-III), if administered on Dec. 31, 2010 or earlier
 Wechsler Intelligence Scale for Children-IV (WISC-IV)
 Stanford-Binet Intelligence Scales-5th ed. (SB-5)
 Woodcock-Johnson Psychoeducational Battery-III General Intellectual Ability (WJ-III GIA)
 Reynolds Intellectual Assessment Scales (RIAS)
 Kaufman Adolescent & Adult Intelligence Test (KAIT)
WAIS-IV Date:
/
/
Full-scale IQ:
Processing Speed Index:
WAIS-III Date:
Working Memory Index:
Verbal Comprehension Index:
/
/
Verbal IQ:
Perceptual Reasoning Index:
Performance IQ:
Full-scale IQ:
Note: WAIS-III results will only be accepted if the battery was administered on or before December 31, 2010.
WISC-IV Date:
/
/
Full-scale IQ:
Processing Speed index:
Working Memory Index:
Verbal Comprehension Index:
Stanford-Binet Intelligence Scales-5th ed. (SB-5) Date:
Perceptual reasoning Index:
/
/
Test Composite (Standard Score):
WJ-III Cognitive Date:
/
/
GIA Score (Standard Score):
Reynolds Intellectual Assessment Scales (RIAS) Date:
/
/
Composite Intelligence Index:
Kaufman Adolescent and Adult Intelligence Test (KAIT)
Date:
/
/
Composite Intelligence Index:
GED® is a registered trademark of the American Council on Education and may not be used or reproduced without express written permission.
LCD Request Form
Page 3 of 7
July 2011
GED® Computer Based Test
REQUEST FOR TESTING ACCOMMODATIONS
LEARNING AND OTHER COGNITIVE DISABILITIES
SECTION THREE: TO BE COMPLETED BY THE
PROFESSIONAL DIAGNOSTICIAN OR ADVOCATE
MEASURES OF ACADEMIC ACHIEVEMENT
Multiple measures of academic achievement must be administered. Two (2) or more achievement tests must be administered in each area
that is claimed to be impaired (reading, written language, or mathematics). We encourage timed as well as untimed testing in each
academic area, although this is not required. Indicate the date(s) of the assessments and include standard scores.
Acceptable Measures of Academic Achievement (acceptable subtests listed below)











Woodcock-Johnson Psychoeducational Battery-III (WJ-III) Tests of achievement
Wechsler Individual Achievement Test-II or III (WIAT-III)
Peabody Individual Achievement Test-R/NU (PIAT-R/NU)
Wide Range Achievement Test-4 (WRAT-4)
Kaufman Tests of Educational Achievement-II (KTEA-II)
Nelson-Denny Reading Test (Form G or H)
Scholastic Abilities Test for Adults (SATA)
Gates-MacGinitie Reading Test (LEVEL AR)
Gray Oral Reading Test-4 (GORT-4); for test-takers <18 years old only
Test of Adolescent & Adult Language-4 (TOAL-4)
Test of Written Language-4 (TOWL-4)
Reading Achievement (untimed)
Reading Achievement (timed)
Date
Date
/
/
/
/
WJ-III letter-Word identification
WJ-III Reading Fluency
WJ-III Passage Comprehension
Nelson-Denny Vocabulary
WJ-III Word attack
Nelson-Denny Comprehension
WIAT-III Word reading
SATA reading vocabulary
WIAT-III Pseudoword Decoding
SATA reading Comprehension
WIAT-III Reading Comprehension
Gates-MacGinitie Reading vocabulary
PIAT-R/NU Reading Recognition
Gates-MacGinitie Reading Comprehension
PIAT-R/NU Reading Comprehension
GORT-4 Oral Reading Quotient
WRAT-4 Reading
KTEA-II Word Recognition Fluency
KTEA-II Letter & Word Recognition
KTEA-II Reading Comprehension
KTEA-II Nonsense Word Decoding
GED® is a registered trademark of the American Council on Education and may not be used or reproduced without express written permission.
LCD Request Form
Page 4 of 7
July 2011
GED® Computer Based Test
REQUEST FOR TESTING ACCOMMODATIONS
LEARNING AND OTHER COGNITIVE DISABILITIES
SECTION THREE: TO BE COMPLETED BY THE
PROFESSIONAL DIAGNOSTICIAN OR ADVOCATE
Written Language Achievement (untimed)
Written Language Achievement (timed)
Date
Date
/
/_______
/
/
WJ-III Writing Samples
SATA Writing Composition
WJ-III Editing
WJ-III Writing Fluency
WIAT-III Written Expression
TOAL- 4 Spontaneous Writing Composite
WIAT-III Sentence Composition
WIAT-III Essay Composition
TOAL- 4 Written language Composite
PIAT-R/NU Written Expression
KTEA-II Written Expression
Mathematics Achievement (untimed)
Mathematics Achievement (timed)
Date
Date
/
/
/
/
WJ-III Calculation
WJ-III Math Fluency
WJ-III Applied Problems
SATA Math Calculation
WJ-III Quantitative Concepts
SATA Math Application
WIAT-II Math reasoning
WRAT-4 Math Computation
WIAT-III Math Problem Solving
WIAT-III numerical Operations
PIAT-R/NU Mathematics
KTEA-II Math Computation
KTEA-II Math Concepts & applications
GED® is a registered trademark of the American Council on Education and may not be used or reproduced without express written permission.
LCD Request Form
Page 5 of 7
July 2011
GED® Computer Based Test
REQUEST FOR TESTING ACCOMMODATIONS
LEARNING AND OTHER COGNITIVE DISABILITIES
SECTION THREE: TO BE COMPLETED BY THE
PROFESSIONAL DIAGNOSTICIAN OR ADVOCATE
DIAGNOSED DISABILITY (IES)
Select all appropriate diagnosed disabilities.
Reading Disability
Written Language Disability
Mathematics Disability
Other cognitive Disabilities (specify diagnosis):
SECTION FOUR: TO BE COMPLETED BY THE
PROFESSIONAL DIAGNOSTICIAN OR ADVOCATE AND THE GED ® TEST TAKER
REQUESTED ACCOMMODATIONS
Extended Time: Standard time + 25%
Extended Time: Standard time + 50%
Extended Time: Standard time + 100%
Supervised breaks: 30 minutes testing/5 minute break
Supervised breaks: 45 minutes testing/10 minute break
Calculator for Part II of the Mathematics Test
Talking Calculator for the entire Mathematics Test*
Other:
*Note: accommodations marked with an * are automatically approved with a Private Room to prevent distraction to other
test-takers.
Additional Information
You may note any information for consideration that is not addressed elsewhere on the request form or included in the attached
supporting documentation. This section cannot be completed in place of attaching the required supporting documentation
GED® is a registered trademark of the American Council on Education and may not be used or reproduced without express written permission.
LCD Request Form
Page 6 of 7
July 2011
GED® Computer Based Test
REQUEST FOR TESTING ACCOMMODATIONS
LEARNING AND OTHER COGNITIVE DISABILITIES
Steps to take after completing request form:
 If you have not done so already, create an account for computer based testing by visiting
www.GEDcomputer.com. Click on register today and enter your legal information with an
accessible email address.
 Once your account is created, you’ll receive an account registration email with an account
activation code.
 Click the activation link in your email and type in the activation code.
 Once activated, change your account username to something you will remember and create a
password before being directed to the welcome page.
 Complete the GED Testing Service® Registration form and indicate you are applying for
accommodations on the exam.
 Review the email from GED Testing Service® that provides the mailing address and/or fax for
submitting your request, then submit your request.
 Allow up to 30 days for GED Testing Service® to make an accommodations decision; Once a
decision is reached, you will be notified by email and you will be given additional instructions.
Questions? Email us: accommodations@gedtestingservice.com
GED® is a registered trademark of the American Council on Education and may not be used or reproduced without express written permission.
LCD Request Form
Page 7 of 7
July 2011