Analytics Magazine Analytics Magazine, January/February 2014 | Page 114

Certification Examination Special Accommodations Form Certified Analytics Professional (CAP®) Credential Please PRINT the following information. TO BE COMPLETED BY CERTIFICATION APPLICANT First name Middle initial ® Last name Email Phone number For further information on the CAP® credential, please visit www.INFORMS.org/certification Please describe the disability that significantly impairs your ability to complete the CAP® examination. Please list the specific testing accommodation requested. Feel free to use additional separate sheets if needed. Note: You must also provide the INFORMS Certification Department with written documentation from a licensed/certified healthcare provider supporting the need for the accommodation requested. This documentation should include a statement describing your disability, diagnosis of your health condition, and a specific recommendation for the type of accommodation requested. INFORMS will not be able to process any request for an accommodation related to compliance with the Americans with Disabilities Act of 1990 until both this Accommodation Request form and the required healthcare provider documentation have been submitted to INFORMS. Signature Date