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Mpleted by Applicant (Please type or legibly print.) APPLICANT NAME: ADDRESS: DAY TIME PHONE: SOCIAL SECURITY NUMBER: DATE OF EXAM YOU ARE SEEKING ACCOMMODATIONS: Month: Year: ******************** 1. Describe the physical or mental impairment that is the basis for your request for testing accommodations and explain the impact of this impairment on your ability to take the Bar Examination under standard testing conditions. Be as specific as possible.

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