Get Form 1404az Request For Ada ... - Headmaster

This guide provides comprehensive instructions on how to effectively complete the FORM 1404AZ REQUEST FOR ADA accommodation. Following these steps will assist you in submitting your request for necessary accommodations related to the Nurse Aide Competency Examination.

Follow the steps to successfully complete your ADA accommodation request form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Carefully enter your name, ensuring to fill in your first and last name accurately.
3. Provide your social security number by entering the digits in the specified format.
4. Fill in your address, including street, city, state, and zip code.
5. Enter your email address and phone numbers to ensure HEADMASTER can contact you.
6. Indicate your date of birth by selecting the appropriate date.
7. Select the types of accommodations you are requesting; mark all that apply including options like oral, additional time, and large print.
8. Describe your disability clearly, highlighting how it limits your major life activities.
9. Explain how your disability impacts your ability to take the NA examination.
10. Detail the specific accommodations you are requesting during the examination.
11. Include past accommodations received during your Nursing Assistant Training Program.
12. Attach any required documentation to support your request, ensuring it meets the outlined guidelines.
13. Sign and date the form to confirm your understanding and permission regarding information sharing.
14. If applicable, have your primary instructor sign the form to verify accommodations provided during training.
15. Review all information for accuracy, then save changes, download the document, and share it as needed before submitting it.

Submit your ADA accommodation request online today!