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CBI/CBPE Examination
DOCUMENTATION OF
DISABILITY-RELATED NEEDS
Please have this section completed by an appropriate professional (education professional, physician, psychologist,
psychiatrist) to ensure that AMP is able to provide the required test accommodations.
Professional Documentation
I have known ______________________________________________ since _____ / _____ / _____ in my capacity as a
Test Candidate Date
__________________________________________________________.
Professional Title
The candidate discussed with me the nature of the test to be administered. It is my opinion that, because of this
candidates disability described below, he/she should be accommodated by providing the special arrangements listed
on the reverse side.
Comments: _______________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Signed: ________________________________________________________________ Title: ____________________________
Printed Name: ___________________________________________________________________________________
Address: _______________________________________________________________________________________
_______________________________________________________________________________________________
Telephone Number: ______________________________________________________________________________
Date: _____________________________________________ License # (if applicable): _______________________________
Return this form with your examination application and fee to:
NFPA Certification Department, 1 Batterymarch Park, Quincy, MA 02169-9101.
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