Get Special Accommodation Request Form - Insurance Ca

Filling out the Special Accommodation Request Form - Insurance Ca is an important step for individuals seeking necessary accommodations for examinations due to disabilities. This guide outlines the process clearly to facilitate an efficient online submission for users with diverse needs.

Follow the steps to effectively complete your accommodation request form.

1. Press the ‘Get Form’ button to access the Special Accommodation Request Form - Insurance Ca online and open it in your browser for completion.
2. Begin by entering the date in the designated field at the top of the form.
3. In the 'Legal Name' section, provide your last name, first name, and middle name as they appear on official documents.
4. Fill in your complete address, including street, city, state, and zip code.
5. Enter your home and work telephone numbers in the respective fields, ensuring the area codes are included.
6. Provide your email address for communication purposes.
7. Check any special arrangements you require based on your documentation, such as reader assistance, large-print examination, extended time, or ESL accommodation. Ensure that the selections match the supporting documents.
8. If requesting ESL accommodation, attach a personal letter and documentation from your English instructor or sponsoring organization, stating that English is not your primary language.
9. After completing the form, fax it along with the required supporting documentation to the specified CDI number.
10. Ensure you register and pay for your examination online with the relevant examination provider after CDI processes your request.
11. Wait for the CDI’s Examination Section Special Accommodations Staff to contact you with further instructions regarding your examination scheduling.

Complete your Special Accommodation Request Form online today for timely assistance in your examination process.