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Certification ADA Accommodation Request Form

Individuals requesting ADA accommodations for an ACI Certification exam should complete this ADA Accommodation Request Form and submit it along with the required physician’s letter or supporting documentation. Providing this information ensures ACI can review your request, determine appropriate accommodations, and coordinate with your selected Sponsoring Group. Please submit all materials as early as possible to allow sufficient time for evaluation.

Name:
ACI Cert ID:
Address:
City:
Country:
State:
Postal Code:
Email Address:
Phone Number:
Name of SG/Testing Center:
 
ACI Cert program that you are seeking:
 
Examination Date:
Seeking accommodation on:

Physician's letter or IEP: