MN Accommodations Form 4: Fill out & sign online

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Click ‘Get Form’ to open the MN Accommodations Form 4 in the editor.
Begin by filling out your personal information in the Applicant’s section, including your full name, date of birth, and evaluation dates. Ensure accuracy as this information is crucial for processing your request.
Sign the permission statement allowing the qualified professional to release necessary information. This step is essential for compliance with the Minnesota Board of Law Examiners (MBLE).
Next, provide details about the evaluator or treating professional. Include their name, contact information, and qualifications. This section helps establish credibility for your accommodation request.
In the Diagnosis and Current Functional Limitations section, ensure that all axes of diagnosis are completed thoroughly. Describe symptoms and limitations clearly to support your case.
Finally, review all sections for completeness before submitting it back to your qualified professional for their input and signature.

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