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To register in the ECFVG certification program, an applicant must submit the following to the ECFVG office:

1. A completed and notarized ECFVG application form (Appendix 1) that must include a passport, green card, or Social Security card number.
   1. Please note: application form is for registration in the ECFVG certification program and not for registration for the BCSE or CPE. BCSE and CPE application requires submission of separate forms.
   2. For candidates registering on and after January 1, 2010, the AVMA is offering complimentary AVMA membership for the remainder of the year. AVMA membership is not required for ECFVG certification, nor does AVMA membership infer any license to practice or guarantee that certification will be awarded. ECFVG candidate information remains confidential within the ECFVG program only and is not shared beyond address and phone number with membership. Please check "AVMA membership interest" on page 3 of the ECFVG application form.
2. Two passport-sized photographs of the applicant.
3. Certified, notarized, or official (issued directly by school) photocopies of the applicant's veterinary college diploma and transcripts (for each year), both in the language of issuance and as a certified English translation if necessary. Provisional Certificates and Certificates of Graduation are unacceptable for ECFVG program purposes. If the applicant is enrolled in the final year of study at an AVMA-listed veterinary college, a letter from an official of that college must also be submitted stating that the applicant will graduate within the year.
4. Payment of $1,000.00 (USD; $275.00 ECFVG program application fee; $725.00 ECFVG Quality Assurance Program [QAP] fee) can be made by credit card (Visa or MasterCard), by personal check from a US bank only, or by cashier's check or money order. Checks or money orders should be made payable to the AVMA. If paying by credit card, please submit the following information with your application:
   1. Type of credit card (Visa or MasterCard)
   2. Credit card number
   3. Expiration date
   4. Name and billing address for credit card if different from name and address on ECFVG application

All items must be sent to: ECFVG, American Veterinary Medical Association, 1931 N Meacham Road, Suite 100, Schaumburg, IL 60173-4360, USA.

If a candidate wishes to withdraw from the program within 60 days after applying, the entire $1,000.00 fee will be refunded upon written or E-mail request. No fees will be refunded for withdrawal requests received more than 60 days after initially applying to the program.

The original registration fee is valid for two years. To remain active in the program, candidates must re-register every two years by notifying the ECFVG and, beginning January 1, 2008, paying a $100.00 re-registration fee. Files of candidates who do not re-register in the ECFVG certification program will be made inactive. An inactive file may be reactivated within eight years upon the written request of the candidate and payment of all past-due re-registration fees. Inactive candidate files older than eight years will be destroyed. Future entrance into the ECFVG certification program would require new registration according to guidelines currently in effect.

The ECFVG verifies all applicants' educational credentials. The ECFVG Coordinator sends a "certification of graduation" form (Appendix 2) with the applicant's photograph to the dean of the veterinary college from which the applicant graduated. The dean or other college official must verify the applicant's identification and graduation date and return the completed form with the college seal affixed to the ECFVG office. Applicants may proceed with the other steps of the program while verification is being obtained.

Once enrolled, candidates must submit address and name change requests in writing or E-mail, listing both the old and new address, or old and new name, and any relevant changes in telephone numbers or E-mail addresses. Name changes must be substantiated with a copy of appropriate legal documents.

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To complete Step 2, non-native English speaking candidates must provide the ECFVG with proof of comprehension and ability to communicate in the English language by meeting the minimum requirements established by the ECFVG on one of the following assessment tools: the TOEFL, TWE, and TSE (computer- or paper-based); the internet-based TOEFL (iB-TOEFL); the IELTS; or the CAEL Assessment.

The TOEFL, TWE, and TSE and the iB-TOEFL are offered by Educational Testing Service (ETS Corporate Headquarters, Rosedale Road, Princeton, NJ 08541; Web site: www.toefl.org; telephone: 609-921-9000).

For ECFVG program purposes, candidates choosing to take the TOEFL (computer-, internet-, or paper-based) MUST take each subsection of the TOEFL. Please note that the TWE is contained within the computer-based/paper-based TOEFL as the essay rating, whereas the TSE is a separate examination. The ECFVG will continue to accept paper-based and computer-based TOEFL/TWE and separate TSE scores until ETS discontinues those examinations worldwide. The iB-TOEFL comprises four sections: listening, reading, writing, and speaking, and candidates taking the iB-TOEFL are not required to take the TSE. Candidates must contact ETS for information regarding the iB-TOEFL or the paper- or computer-based TOEFL/TWE and TSE, including dates and location of examinations, fees, and application procedures.

For ECFVG program purposes, the minimum requirements for the computer-based TOEFL is 213 with at least 25 points in listening comprehension (section 1); the minimum required score on the TWE (TOEFL essay section) is 4.0; and the minimum required score on the TSE is 50. The ECFVG CANNOT accept section scores from separate computer-based TOEFL/TWE exam administrations; candidates MUST achieve at least the minimum passing scores for all required sections of the computer-based TOEFL/TWE on the same exam administration.

The minimum requirements for the paper-based TOEFL is 550 with at least 60 points in listening comprehension (section 1); the minimum required score on the TWE (TOEFL essay section) is 4.0; and the minimum required score on the TSE is 50. The ECFVG CANNOT accept section scores from separate paper-based TOEFL/TWE exam administrations; candidates MUST achieve at least the minimum passing scores for all required sections of the paper-based TOEFL/TWE on the same exam administration.

On the basis of a standard setting exercise conducted in June 2008, the ECFVG has determined the following minimum requirements for the iB-TOEFL: 25 in listening, 22 in writing, 22 in speaking, and 23 in reading; no minimum overall score is required. Candidates MUST achieve at least the minimum passing scores for each of the four sections of the iB-TOEFL, with section scores accepted from separate iB-TOEFL exam administrations conducted over a two-year period.

The ECFVG requires original score reports directly from ETS; copies are not acceptable. ECFVG candidates must request their TOEFL/TWE and TSE scores or iB-TOEFL scores be reported directly to ECFVG by ETS. Please use institution code 1212 when requesting score reports. Because ETS only maintains score reports for two years from the date of examination, candidates should plan accordingly to ensure that score reports do not expire before requesting that they be submitted to the ECFVG. Moreover, the ECFVG office cannot hold score reports longer than two years for individuals who are not currently enrolled in the ECFVG certification program. However, once an enrolled ECFVG candidate submits a passing score report, that score report will remain valid as long as the candidate remains actively enrolled in the ECFVG program.

The International English Language Testing System (IELTS) is administered by the University of Cambridge Local Examinations Syndicate, the British Council, and IDE Education Australia. For information in North America, contact IELTS Inc at 100 East Corson St, Suite 200, Pasadena, CA 91103 (Web site: www.ielts.org; telephone: 626-564-2954).

For ECFVG program purposes, candidates choosing to take the IELTS MUST take the academic IELTS. The minimum required score on the academic IELTS is 6.5 (overall band score), with at least a 6.5 in the listening band, a 6.0 in the writing band, and a 7.0 in the speaking band. Candidates MUST achieve at least the minimum required scores for each of the required four sections of the IELTS, with section scores accepted from separate IELTS examination administrations conducted over a two-year period. The ECFVG requires original score reports directly from IELTS Inc.

The Canadian Academic English Language (CAEL) Assessment is administered by Carleton University. Please contact the CAEL Assessment Testing Office, 228 Paterson Hall, Carleton University, 1125 Colonel By Drive, Ottawa, Ontario, Canada K1S 5B6 (Web site: www.cael.ca; telephone: 613-520-2600, ext 2271).

For ECFVG program purposes, candidates choosing to take the CAEL Assessment MUST take each subsection of the CAEL Assessment. The minimum required score on the CAEL Assessment is 60 (overall score), with at least a 60 in the listening band, a 50 in the writing band, and a 60 in the speaking band. The ECFVG CANNOT accept section scores from separate exam administrations; candidates MUST achieve at least the minimum required scores for all required sections of the CAEL Assessment on the same exam administration. The ECFVG requires original score reports directly from the CAEL Assessment Testing Office.

For candidates whose native language (ie, the common language of an individual's country of birth) is English, the English language examinations may be waived. To do so, eligible candidates must provide documentation of at least three years full-time attendance at a secondary (high) school at which the complete language of instruction was English. Acceptable documentation includes a letter directly from school officials stating dates of attendance (month and year of both initial and final dates of attendance are required) and verifying that the complete language of instruction was English or, for graduates of US high schools, a certified, notarized, or official copy of the final diploma or transcript. A degree from an English-speaking college or university is not considered adequate proof of English language ability.

Beginning January 1, 2010, the ECFVG will verify all applicant's documentation for waiver of the English language examination requirement as follows: after receiving documentation directly from the candidate's secondary school, the ECFVG Coordinator will send a "Verification of English Language" form (Appendix 3) to the principal of that school to verify dates of attendance and that the complete language of instruction was English.

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To complete Step 3, candidates must attain a passing score on the Basic and Clinical Sciences Examination (BCSE). Candidates who took the North American Veterinary Licensing Examination (NAVLE) during the April 2007 or prior administrations ONLY, or the National Board Examination (NBE) and Clinical Competency Test (CCT) prior to 2000 may be eligible to use successful score reports from those prior examinations to complete ECFVG Step 3.

The ECFVG Coordinator will notify candidates of their eligibility to apply for the Step 3 examination and will send candidates a BCSE application via US mail (Appendix 4; provided here as an example only; a valid BCSE application is one sent by the ECFVG office to an eligible candidate). Please note that candidates only become eligible to apply for and take the BCSE upon successful completion of ECFVG Step 2.

The AVMA owns and administers the BCSE, which is an approximately four-hour computer-based examination consisting of 225 multiple-choice questions designed to help assess basic and clinical veterinary sciences knowledge. Complete information on the BCSE, including application procedures and deadlines, rescheduling rules, rules of conduct, and testing accommodations, can be found in the BCSE Candidate Bulletin. All candidates must review this document before taking the BCSE.

The Canadian National Examining Board (NEB; http://canadianveterinarians.net/about-programs-structure-examining.aspx) also uses the BCSE as part of its certification program. NEB candidates must register for the BCSE through the NEB office; score reports for NEB candidates will also be through the NEB office. Both ECFVG and NEB candidates may reserve only a single testing seat per BCSE window, regardless through which agency that singe testing seat is reserved.

For ECFVG candidates taking the BCSE, scores will automatically be entered into candidate files; a passing score will result in completion of ECFVG Step 3 and successful candidates will then be notified of their eligibility to apply for ECFVG Step 4, the Clinical Proficiency Examination (CPE). Both passing and failing BCSE scores will also be reported directly to candidates by the Testing Coordinator via US mail only. BCSE scores will not be available to candidates via telephone, E-mail, or fax.

For ECFVG candidates who have successfully completed the NAVLE during or prior to the April 2007 administration or the NBE and CCT prior to 2000, the ECFVG requires original NAVLE or NBE/CCT score reports directly from the Veterinary Information Verifying Agency (VIVA) of the American Association of Veterinary State Boards (AAVSB). NAVLE and NBE/CCT scores are ONLY reported to the ECFVG at the request of the ECFVG candidate. Requests for score transfers must be directed to the VIVA, 380 W. 22nd Street, Suite 101, Kansas City, MO 64108 (Web site: www.aavsb.org; telephone: 877-698-8482) The ECFVG office will notify each applicant when his/her scores have been received. Again, VIVA will not report scores to the ECFVG without a request from the candidate, and the ECFVG will consider Step 3 complete only on receipt of a score report from VIVA indicating a passing score on the NAVLE (April 2007 and previous administrations only) or the NBE and CCT (prior to spring 2000).

ECFVG candidate addresses listed on Step 3 examination score reports (BCSE, NAVLE or NBE/CCT) that vary from the address on record must be explained in writing, listing both the old and new address, before ECFVG can record and acknowledge receipt of the score report. Therefore, it is important that all candidates provide the ECFVG office with address updates as soon as possible. Address changes must be in writing or E-mail.

For information regarding the NAVLE, which is a licensing examination, please contact the National Board of Veterinary Medical Examiners (NBVME), PO Box 1356, Bismarck, ND 58502 (Web site: www.nbvme.org; telephone: 701-224-0332).

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Only the Clinical Proficiency Examination (CPE) approved by the ECFVG will meet the requirements for assessment of hands-on clinical skills. Further, to complete Step 4, candidates must attain a passing score on all sections of the CPE. The Canadian National Examining Board (NEB; http://canadianveterinarians.net/about-programs-structure-examining.aspx) also uses the CPE as part of its certification program. NEB candidates must register for the CPE through the NEB office; CPE score reports for NEB candidates will also be through the NEB office. Both ECFVG and NEB candidates may only reserve a single full or retake CPE position at any one time, regardless through which agency that single testing seat is reserved.

CPE Format
The CPE is a 3-day, 6-section, hands-on clinical skills examination, administered by the faculty of a college of veterinary medicine or other authorized testing institution. The skill level expected for a passing grade on each of the 6 sections of the CPE is that of an entry-level graduate of an accredited veterinary college. Only well-prepared candidates will be able to pass the CPE.

The 6 sections of the CPE include: anesthesia, diagnostic techniques, equine practice, food animal practice, small animal medicine, and surgery. The CPE Manual of Administration describes specific sections and skills to be assessed and serves as the guide for administering the CPE to all candidates. All sites offering the CPE must adhere to the standards set forth in the CPE Manual and 2 other quality assurance documents (Appendices 5 and 6)

CPE Eligibility
All candidates will be notified of their Step 4 eligibility by letter from the ECFVG Coordinator. ECFVG candidates who are graduates of AVMA-listed veterinary colleges become eligible to apply for and take the CPE after completing Steps 1, 2, and 3 of the certification program (Appendix 7). Candidates who register in the ECFVG program during their final year of studies at an AVMA-listed veterinary college become eligible to apply for the CPE after completing Steps 2 and 3 of the ECFVG certification program but cannot select or be assigned to a CPE date prior to their anticipated graduation date (Appendix 8). Furthermore, Step 1 must be completed before the first day of the assigned CPE, and Step 1 is considered complete only after the ECFVG processes copies of the candidate's veterinary college diploma and final transcripts. ECFVG policy also states that this documentation must be received not later than 60 days prior to the date of the assigned CPE, so candidates should plan accordingly. Additionally, candidates who complete any portion of their clinical education at an AVMA-accredited veterinary college cannot take the CPE administered at that college.

Full CPE Fees
All fees for the full CPE are non-refundable and non-transferable. The full CPE fee is $5,000 for ECFVG candidates who initially registered in the certification program on and after January 1, 2006 and who have paid a one-time ECFVG QAP fee on program registration. The full $5,000 CPE fee is forwarded to the site administering the CPE.

The full CPE fee is $6,000 for ECFVG candidates who initially registered in the certification program prior to January 1, 2006; $1,000 covers the maintenance of the CPE Quality Assurance Program (QAP), while the remaining $5,000 is forwarded to the site administering the CPE to help defray examiners' salaries, facility and equipment costs, animal procurement and maintenance costs, and other associated expenses.

The following fee schedule for the full exam applies:

1. For candidates who initially registered in the certification program on/after January 1, 2006:
   • $5,000 CPE fee (non-refundable/non-transferable)—$500 due when requesting an application, $500 due when returning a completed application, and the remaining balance ($4,000) due 60 days prior to examination.
2. For candidates who initially registered in the certification program prior to January 1, 2006:
   • $1,000 QAP fee (non-refundable/non-transferable)—$500 due when requesting an application, and the remaining balance due 60 days prior to examination.
   • $5,000 CPE fee (non-refundable/non-transferable)—$500 due when returning a completed application, and the remaining balance due 60 days prior to examination.

PLEASE NOTE: CPE fees (full or retake) cannot be refunded if you fail to receive a visa or other required travel documentation to allow travel to the CPE site. Make sure all documents permitting travel are in place prior to submitting your non-refundable/non-transferable fees. Please also make sure all other CPE policies (eg, rescheduling, concomitant enrollment in the NEB certification program) are understood before submitting your CPE application and payment, as all fees are non-refundable and non-transferable. Please contact the Testing Coordinator if you have any questions regarding these policies

The final balance must be sent (post-marked) to the AVMA/ECFVG no later than 60 days prior to the scheduled exam. Final payment must be in the form of a cashier's check or money order made payable to the AVMA. FAILURE TO PAY THIS BALANCE BY THE REQUIRED DEADLINE WILL RESULT IN FORFEITURE OF ALL FEES AND LOSS OF THE RESERVED EXAMINATION SPACE.

Application Process for the Full CPE
The ECFVG office will notify candidates in writing (Appendix 7 or 8) when they have attained CPE eligibility. After receiving written notification from the ECFVG office, eligible candidates must request a CPE application in writing (Appendix 9; provided here as an example only; valid CPE applications are only available to eligible candidates upon request and with initial deposit from the ECFVG office). Candidates requesting testing accommodations must also request the ECFVG Test Accommodation Request Form for the CPE (Appendix 10). Candidates must also include an initial deposit, in the form of a cashier's check or money order for $500 (non-refundable/non-transferable) payable to the AVMA, with the request for a CPE application.

Once a candidate's request and initial deposit are processed, the Testing Coordinator will send the candidate a CPE application and Manual of Administration. The Manual of Administration provides candidates with detailed information regarding skills to be assessed during this hands-on examination. Candidates complete the application by indicating their top five preferred CPE dates/locations. The completed application must be returned to the AVMA office together with the second deposit in the form of a cashier's check or money order for $500, made payable to the AVMA. Each candidate must submit the deposit and completed application in order to reserve an examination space. After processing a candidate's completed application, the Testing Coordinator will forward the candidate a letter confirming the date and location of the scheduled CPE. Examination dates are assigned on a first-come/first-serve basis.

PLEASE NOTE: CPE fees cannot be refunded if you fail to receive a visa or other required travel documentation to allow travel to the CPE site. Make sure all documents permitting travel are in place prior to submitting your non-refundable/non-transferable fees. Please also make sure all other CPE policies (eg, rescheduling, ECFVG reciprocity with the NEB certification program) are understood before submitting your CPE application and payment, as all fees are non-refundable and non-transferable. Please contact the Testing Coordinator if you have any questions regarding these policies

Scoring the CPE
Passing scores in all sections of the CPE are required to pass the examination. A candidate who fails 4 or more sections of the examination must repeat the entire CPE. Candidates who fail 1, 2, or 3 sections of the CPE are allowed two additional opportunities to retake and successfully pass the failed sections as long as the candidates apply for a retake within 6 months of each failure and accept one of the first available retakes offered. Failure to successfully pass the retake sections within these 2 attempts or failure to accept the first available retakes will necessitate the candidate retaking the entire CPE. Please note: only a total of two retake attempts are allowed for each failed section, regardless whether those attempts are at an ECFVG- or NEB-approved CPE site.

Each CPE site will report scores to the ECFVG office within 15 working days of the last day of the examination. The ECFVG office will notify candidates of their results (ie, pass or fail) on each section. Such notification will be via US mail only. Scores cannot be reported via telephone, E-mail, or fax.

An unsuccessful candidate may request feedback on failed sections from the ECFVG office. This information will assist the candidate in identifying his/her deficiencies and to devise a plan for upgrading. Candidates are prohibited from contacting examiners for feedback either during or following completion of the CPE.

CPE Retake Fees
All fees for to retake failed sections of the CPE are non-refundable and non-transferable. For ECFVG candidates initially registered in the certification program on or after January 1, 2006, the fee to retake 1, 2, or 3 sections of the CPE is $1,250 per section, with the total fee forwarded to the CPE site. For ECFVG candidates initially registered in the certification program prior to January 1, 2006, the fee to retake 1, 2, or 3 sections of the CPE is $1,500 per section; $250 covers the maintenance of the CPE QAP, while the remaining $1,250 is forwarded to the site administering the CPE to help defray examiners' salaries, facility and equipment costs, animal procurement and maintenance costs, and other associated expenses.

PLEASE NOTE: CPE fees cannot be refunded if you fail to receive a visa or other required travel documentation to allow travel to the CPE site. Make sure all documents permitting travel are in place prior to submitting your non-refundable/non-transferable fees. Please also make sure all other CPE policies (eg, rescheduling, concomitant enrollment in the NEB certification program) are understood before submitting your CPE application and payment, as all fees are non-refundable and non-transferable. Please contact the Testing Coordinator if you have any questions regarding these policies

Application Process for Retaking Failed CPE Sections
Candidates retaking one or more sections must also request a CPE application in writing from the AVMA/ECFVG and must include a $250 non-refundable/non-transferable deposit for each section in the form of a cashier's check or money order made payable to AVMA. To reserve the examination space, candidates retaking sections must return the completed application to the AVMA/ECFVG together with the final payment in the form of a cashier's check or money order payable to AVMA in the amount of $1,250 per section for candidates initially registered in the ECFVG certification program prior to January 1, 2006 or $1,000 per section for candidates initially registered in the ECFVG certification program on or after January 1, 2006.

PLEASE NOTE: CPE fees cannot be refunded if you fail to receive a visa or other required travel documentation to allow travel to the CPE site. Make sure all documents permitting travel are in place prior to submitting your non-refundable/non-transferable fees. Please also make sure all other CPE policies (eg, rescheduling, concomitant enrollment in the NEB certification program) are understood before submitting your CPE application and payment, as all fees are non-refundable and non-transferable. Please contact the Testing Coordinator if you have any questions regarding these policies

Rescheduling a Full CPE or Retake Sections
Candidates may only reschedule a confirmed CPE date (full or retake sections) without forfeiture of all fees paid because of a medical condition pertaining to the candidate or a death in the immediate family; written verification from a doctor or other appropriate authority is required. All rescheduling requests will be granted at the discretion of the ECFVG. Requests must be forwarded as soon as possible in writing to the ECFVG Testing Coordinator and include documentation as listed in this section.

CPE Rules of Conduct
The ECFVG has established Rules of Conduct to govern administration of the CPE to ensure that no examinee or group of examinees receives unfair advantage on the examination, inadvertently or otherwise.

If there is a reason to believe that the integrity of the examination process is jeopardized, the ECFVG may invalidate all or any part of a CPE administration. If information indicates that continued testing would jeopardize the security of examination materials or the integrity of scores, the ECFVG reserves the right to suspend or cancel any CPE administration.

CPE site team members (ie, coordinators, examiners, technicians, and assistants) monitor all sections of the CPE. If CPE site team members observe a candidate violating the Rules of Conduct or engaging in other forms of irregular behavior during a CPE, the team members will not necessarily advise the candidate at the time of the examination, but shall report such incidents to the ECFVG. Each report shall be fully investigated.

By applying to take the CPE, a candidate agrees to the following Rules of Conduct:

• You are the person named on the CPE application.
• You will place in a locker or cubicle or other designated area all personal belongings, including cellular telephones, watches with computer communication and/or memory capability, pagers, personal digital assistants (PDAs), formulas, study materials, notes, papers, and your purse or wallet, before you enter the secure testing areas.
• You will not use a telephone at any time while you are in the secure areas.
• You will not give, receive, or obtain any form of unauthorized assistance during the testing session, including any breaks.
• You will not have in your possession any formulas, study materials, notes, papers, or electronic devices of any kind unless you are out of the secure testing areas of the CPE site.
• You will not remove materials in any form (written, printed, recorded, or any other type) from the secure testing area unless instructed to do so by the examiners.
• You understand and acknowledge that all examination materials remain the property of the CPE site and ECFVG, and you will maintain the confidentiality of the case content for all sections of the CPE. You will not reproduce or attempt to reproduce examination materials through memorization or any other means, nor will you provide information relating to examination content that may give or attempt to give unfair advantage to individuals who may be taking the examination, including, without limitation, by posting information regarding examination content on the Internet.

Unless specifically authorized, candidates may not bring personal belongings into secure testing areas of the CPE site. Failure to follow these rules shall constitute a violation of the Rules of Conduct for the administration of the CPE and may lead to adverse action regarding a candidate's examination. For the CPE, candidates should understand that the entire testing session over the 3 -day testing period, including all breaks, is considered a closed and secure testing session, and that the entire CPE site, including any on-site lunch room, break rooms, and restrooms, is a secure testing area. Therefore the rules regarding unauthorized possession during the CPE extend to lunch, if lunch is provided on site, and all breaks.

For the CPE, unauthorized personal belongings include, but are not limited to:

• mechanical or electronic devices other than simple calculators, such as cellular telephones, personal digital assistants (PDAs), watches with computer communication and/or memory capability, electronic paging devices, recording or filming devices, radios;
• outerwear, such as coats, jackets, head wear, gloves;
• book bags, backpacks, handbags, briefcases, wallets; and
• books, notes, study materials, or scratch paper.

If candidates bring any personal belongings to the CPE site, they must store them in a designated locker or storage cubicle or other designated area as directed by the CPE site team. All stored mechanical or electronic devices must be turned off. Upon reasonable suspicion, a candidate's personal belongings and their contents may be inspected. Any materials that reasonably appear to be reproductions of any case material specific for the CPE administration in which a candidate is participating will be confiscated. Making notes of any kind during the CPE, except on the materials provided by the CPE site for this purpose, is not permitted. If candidates have any questions regarding the appropriateness of personal belongings to be brought into the CPE site, contact the ECFVG or a CPE site team member prior to admission.

Admission to the CPE—When candidates arrive at the CPE site for orientation and check in, they must present a photo ID with signature. Acceptable forms of identification include the following forms of unexpired identification:

• passport;
• driver's license;
• national identity card; or
• other form of unexpired, government-issued identification.

The identification must contain both the candidate's signature and photograph. If a candidate does not bring acceptable identification, he/she will not be admitted to the CPE. In that event, the candidate will be required to reschedule the CPE in accordance with current ECFVG policy. The candidate's name as it appears on his/her CPE application must match the name on the form(s) of identification exactly. If a candidate's name listed on his/her CPE application is not correct, contact the ECFVG office immediately at ECFVG@avma.org or 800-248-2862, ext 6682 or 6623.

Test Centers and Testing Conditions—The time and location for arrival at the CPE site for orientation and check in will be sent to each candidate by US mail prior to the administration of the examination. If a candidate arrives late, he/she will not be admitted, and will have to reschedule the test date in accordance with current ECFVG policy.

At the time of check-in, candidates will be required to present unexpired identification. Prior to beginning each day of the examination, candidates will be directed to a small storage cubicle or locker or other designated area in which they must place personal belongings. These cubicles may not be secure, so do not bring valuables.

In addition, candidates should please note the following:

• You should bring only the equipment specified for each section within the CPE Manual of Administration; all other equipment is provided at the CPE
• You should wear comfortable, professional clothing.
• There are no waiting facilities for family and friends at the center; plan to meet them elsewhere after the examination ends.
• CPE site team members (wearing name tags) will direct you throughout each day of the CPE, and their instructions should be followed at all times.
• There will be an on-site orientation to each section of the CPE to acquaint candidates with specific procedures and regulations.

Once candidates enter the secure testing area of the CPE site, they may not leave that area until directed to do so by a member of the CPE site team. Breaks, including a lunch break, are provided. CPE site team members will direct candidates to any on-site break and lunch rooms. Candidates may not discuss the cases with fellow examinees at any time, and conversation among examinees in any language other than English is prohibited at all times. CPE site team members will monitor all examinee activity. See "Irregular Behavior" below.

CPE site team members are not authorized to answer questions from examinees regarding examination content or scoring.

Should a candidate wish to file a concern regarding the CPE testing experience, he/she may do so at the site on the test day(s). If a candidate does not file a report at the site, he/she must notify the ECFVG office in writing within three weeks of the final day of the administration of the CPE. Concerns that are reported in this way will be investigated in accordance with the current ECFVG Complaints Procedure (available at www.avma.org/education/ecfvg/ecfvg_pp_complaints.asp).

Irregular Behavior—Irregular behavior consists of any action by CPE candidates or others that subverts or attempts to subvert the examination process, including, without limitation:

• Falsification of information on the application form, including additional documentation, or failure to provide the ECFVG with information material to your application.
• Impersonating an examinee or engaging someone else to take the examination for you
• Giving, receiving, or obtaining unauthorized assistance during the examination, or attempting to do so.
• Unauthorized possession, reproduction, or disclosure of any materials, including, but not limited to, examination cases, before, during, or after the examination.
• Making notes of any kind during an examination except on the writing materials provided by the CPE for that purpose.
• Disruptive or unprofessional behavior at a CPE site.
• Offering any benefit to any CPE site team member or agent of the ECFVG in return for any right, privilege, or benefit which is not usually granted by the ECFVG to other similarly situated candidates.

If a candidate is determined to have failed to abide by the Rules of Conduct of the ECFVG or otherwise to have engaged in any form of irregular behavior, the ECFVG may terminate the candidate's participation in an examination, invalidate the results of an examination, withhold or revoke the candidate's scores or certification, bar the candidate's participation in future examinations, and/or take other appropriate adverse action. In addition, such determination shall become part of the candidate's permanent ECFVG record and the fact of such determination may be provided to third parties that receive or have received verification of ECFVG status. Such information may also be provided to other legitimately interested entities.

Candidates also should understand that the ECFVG may or may not require a candidate to retake one or more portions of the ECFVG if presented with sufficient evidence that the security of the examination has been compromised, notwithstanding the absence of any evidence of a candidate's personal involvement in such activities.

Appeal Process—Candidates determined to have violated the Rules or Conduct or otherwise engaged in irregular behavior may appeal the decision by following the current ECFVG Appeal Procedure (www.avma.org/education/ecfvg/ecfvg_pp_appeal.asp).

CPE Testing Accommodations
Introduction—In accordance with the Americans with Disabilities Act and other applicable laws, the AVMA/ Educational Commission for Foreign Veterinary Graduates (ECFVG) provides equal access to programs and services for individuals with documented disabilities.

The Americans with Disabilities Act of 1990 (ADA) and accompanying regulations define a person with a disability as someone with a physical or mental impairment that substantially limits one or more major life activities such as walking, seeing, hearing, or learning. The purpose of documentation is to validate that the applicant is covered under the ADA. Comprehensive information by a qualified professional is necessary to allow the ECFVG to understand the nature and extent of the applicant's disability and the resulting functional impairment that limits access to its examinations. Documentation also allows the ECFVG to provide appropriate accommodations for such a disability.

Documentation submitted by an applicant in support of a request is reviewed by the ECFVG for consideration and will be forwarded to outside experts for impartial professional review.

The ECFVG Policy on Testing Accommodations provides individuals, schools, professional diagnosticians, and service providers with information regarding how to document a disability and a related need for accommodations for candidates for the ECFVG Clinical Proficiency Examination (CPE). The information and documentation submitted should be as comprehensive as possible in order to allow the ECFVG to make an informed decision on the accommodation request and to avoid time delays in the decision-making process.

The purpose of accommodations is to provide equal access to the CPE. Accommodations "match up" with the identified functional limitation so that the area of impairment is mitigated by an auxiliary aid or adjustment to the testing procedure. Functional limitation refers to the behavioral manifestations of the disability that impede the individual's ability to function; that is, what someone cannot do on a regular and continuing basis as a result of the disability. For example, a functional limitation might be an inability to hear within normal limits. An appropriate accommodation might be use of an amplified stethoscope. It is essential that the documentation submitted with an accommodations request provide a clear explanation of the functional impairment and a rationale for the requested accommodation.

As noted in the CPE Manual of Administration, the Clinical Proficiency Examination (CPE) is a hands-on examination of entry-level educational clinical skills and judgments designed for graduates of non-AVMA/Council on Education (COE)-accredited veterinary colleges. The CPE is intended to assess the practical clinical veterinary skills of an "entry-level" veterinarian (ie, a new graduate of an AVMA/COE-accredited school). The CPE Manual of Administration lists the specific clinical proficiency skills measured by each section of the examination.

The ECFVG will provide reasonable accommodations designed to facilitate equal access to the CPE. Accommodations will be considered on a section-by-section basis. Because of the different clinical skills measured by the different sections, accommodations may be provided for some sections but not for others. In no case will accommodations be provided that would compromise any examination section's ability to test accurately the skills and knowledge it purports to measure. Similarly, no auxiliary aid or service will be provided that will fundamentally alter any section of the examination.

As part of the measurement of clinical "efficiency," candidates are assessed on their timely and effective use of resources to complete a procedure. Efficiency is a component of competency. Therefore, an accommodation of additional testing time will not be provided for those sections that assess efficiency. Similarly, no accommodations, including additional testing time, will be provided where the safety and welfare of an animal may be compromised.

While the use of accommodations in the test activity may enable the individual to better demonstrate his or her mastery of clinical skills, accommodations are not a guarantee of improved performance, test completion, or a passing score.

When to Request Test Accommodations for the CPE—Once the ECFVG office notifies a candidate who requires accommodations that he or she is eligible for the CPE, the candidate should request an ECFVG Test Accommodation Request Form for the Clinical Proficiency Examination (CPE) from the ECFVG office at the same time he or she requests a CPE application. A Test Accommodation Request form is also available in Appendix 10 of this Policies and Procedures Manual. The completed ECFVG Test Accommodation Request Form for the CPE must be submitted to the ECFVG office at the same time as the completed CPE application. Appropriate documentation of the disabling condition and need for accommodations must accompany the Test Accommodation Request Form. In order to facilitate processing, the ECFVG encourages applicants to provide detailed and complete responses to the request for test accommodations and accompanying documentation.

How to Request Test Accommodations for the CPE—If a candidate has a documented disability covered under the Americans with Disabilities Act (ADA) and requires test accommodations, he/she must notify the ECFVG in writing each time he/she applies for an accommodation. The individual requesting accommodations must personally initiate a written request for test accommodations. Accommodation requests by a third party (such as an evaluator or veterinary school) cannot be honored. Candidates should read and comply with the following seven steps to request accommodations:

1. Read the General Guidelines for Documenting Disabilities, Guidelines for Documenting Learning Disabilities, and Guidelines for Documenting Attention-deficit/Hyperactivity Disorder and share them with the professional who will be preparing your documentation. Your treating professional must provide the necessary supporting documentation as described in these guidelines.
2. Complete and sign the ECFVG Test Accommodation Request Form for the Clinical Proficiency Examination (CPE), which may be obtained by requesting a form in writing from the ECFVG office at the time you request a CPE application. Alternatively, if you are applying to retake one, two, or three failed sections of the CPE, complete and sign the ECFVG Request for Subsequent (Retake) Test Accommodations for the Clinical Proficiency Examination (CPE), which may also be obtained on written request from the ECFVG office.
3. Attach documentation of the disability and your need for accommodation.
   1. Compare your documentation with the information listed in the General Guidelines for Documenting Disabilities, Guidelines for Documenting Learning Disabilities, and Guidelines for Documenting Attention-deficit/Hyperactivity Disorder to ensure a complete submission.
   2. Incomplete documentation will delay processing of your request.
4. Attach a personal statement describing your disability and its impact on your ability to function in a clinical setting and in your daily life. If you are currently a practicing veterinarian, also describe any current workplace accommodations.
5. Submit all documentation as outlined in the General Guidelines for Documenting Disabilities, Guidelines for Documenting Learning Disabilities, and Guidelines for Documenting Attention-deficit/Hyperactivity Disorder, including the following:
   1. Typed or printed letters and reports from evaluators on official letterhead.
   2. All documents in English. You are responsible for providing certified English translations of foreign-language documentation.
   3. Records from childhood if you are requesting accommodations based on a developmental disorder such as learning disorders (LD) or attention deficit/hyperactivity disorder (ADHD).
   4. Documentation of your functional impairment in activities beyond test-taking.
   5. Verification of your functional impairment by impartial third-party individuals who have observed you in day-to-day functioning or in clinical situations.
6. Retain a photocopy of all Request Forms and documentation submitted.
7. Send your completed ECFVG Test Accommodation Request Form for the CPE and documentation via a traceable or return-receipt method with your CPE application to:
   AVMA/ECFVG
   Attn: Testing Coordinator
   1931 N. Meacham Rd. Suite 100
   Schaumburg, IL 60173

General Guidelines for Documenting Disabilities—The following guidelines are provided to assist the applicant in documenting a need for accommodation based on an impairment that substantially limits one or more major life activities. To support a request for test accommodations, a candidate must please submit the following documentation from his/her testing professional:

1. A detailed, comprehensive written report describing the candidate's disability and its severity and justifying the need for the requested accommodations. Documentation in support of requests for accommodations on the basis of a learning disability or attention-deficit/hyperactivity disorder must also comply with the Guidelines for Documenting Learning Disabilities or Guidelines for Documenting Attention-Deficit/Hyperactivity Disorder, respectively.
2. The following characteristics are expected of all documentation submitted in support of a request for accommodations. Documentation must:
   1. State a specific diagnosis of the disability. A professionally recognized diagnosis for the particular category of disability is expected (eg, the DSM-IV diagnostic categories for learning disabilities).
   2. Be current. Because the provision of reasonable accommodations is based on assessment of the current impact of the examinee's disability on the testing activity, it is in the individual's best interest to provide recent documentation. As the manifestations of a disability may vary over time and in different settings, in most cases an evaluation should have been conducted within the past three years. For example, low vision or neuromuscular conditions are often subject to change and should be updated for current functioning.
   3. Describe the specific diagnostic criteria and name the diagnostic tests used, including date(s) of evaluation, specific test results, and a detailed interpretation of the test results. This description should include the results of diagnostic procedures and tests utilized and should include relevant educational, developmental, and medical history. Specific test results should be reported to support the diagnosis. For example, documentation for an examinee with multiple sclerosis should include specific findings on the neurological examination including functional limitations and MRI or other studies, if relevant. Diagnostic methods used should be appropriate to the disability and current professional practices within the field. Informal or non-standardized evaluations should be described in enough detail that other professionals could understand their role and significance in the diagnostic process.
   4. Describe in detail the individual's limitations due to the diagnosed disability (ie, a demonstrated impact on functioning on the CPE) and explain the relationship of the test results to the identified limitations resulting from the disability. The current functional impact on physical, perceptual, and cognitive abilities should be fully described (eg, the extent to which an examinee with macular degeneration and resulting reduced central vision is limited in the ability to read).
   5. Recommend specific accommodations and/or assistive devices including a detailed explanation of why these accommodations or devices are needed and how they will reduce the impact of the identified functional limitations. Accommodation requests for the CPE and their justification must be section specific. For example, a request for special lighting might be appropriate for the Surgery section, but not for the Small Animal Practice section. Extra time might be appropriate for the written stations in such sections as Small Animal Practice and Radiology but not for sections requiring demonstration of competencies required in Anesthesia or Surgery.
   6. Establish the professional credentials of the evaluator that qualify him or her to make the particular diagnosis, including information about licensure or certification and specialization in the area of the diagnosis. The evaluator should present evidence of comprehensive training and direct experience in the diagnosis and treatment of adults in the specific area of disability.
3. If no prior accommodations have been provided, the qualified professional expert should include a detailed explanation as to why no accommodations were given in the past and why accommodations are needed now.

Guidelines for Documenting Learning Disabilities—The following information is provided to clarify the documentation process for applicants submitting a request for accommodations based specifically on a learning disability or cognitive impairment.

1. The evaluation must be conducted by a qualified professional. The qualified professional (diagnostician) must have comprehensive training in the field of learning disabilities and must have comprehensive training and direct experience in working with an adult population.
2. Testing/assessment must be current. The determination of whether an individual is significantly limited in functioning according to ADA criteria is based on assessment of the current impact of the impairment. (See General Guidelines for Documenting Disabilities). A developmental disorder such as a learning disability originates in childhood and, therefore, information which demonstrates a history of impaired functioning should also be provided.
3. Documentation must be comprehensive. Objective evidence of a substantial limitation in cognition or learning must be provided. At a minimum, the comprehensive evaluation should include the following:
   1. A diagnostic interview and history taking. Because learning disabilities are commonly manifested during childhood, though not always formally diagnosed, relevant historical information regarding the individual's academic history and learning processes in elementary, secondary and postsecondary education should be investigated and documented. The report of assessment should include a summary of a comprehensive diagnostic interview that includes relevant background information to support the diagnosis. In addition to the candidate's self-report, the report of assessment should include:
      • A description of the presenting problem(s);
      • A developmental history;
      • Relevant academic history including results of prior standardized testing, reports of classroom performance and behaviors including transcripts, study habits and attitudes and notable trends in academic performance;
      • Relevant family history, including primary language of the home and current level of fluency in English;
      • Relevant psychosocial history;
      • Relevant medical history including the absence of a medical basis for the present symptoms;
      • Relevant employment history;
      • A discussion of dual diagnosis, alternative or co-existing mood, behavioral, neurological and/or personality disorders along with any history of relevant medication and current use that may impact the individual's learning; and
      • Exploration of possible alternatives that may mimic a learning disability when, in fact, one is not present.
   2. A psychoeducational or neuropsychological evaluation. The psychoeducational or neuropsychological evaluation must be submitted on the letterhead of a qualified professional, and it must provide clear and specific evidence that a learning or cognitive disability does or does not exist. It must also have the following characteristics:
      • The assessment must consist of a comprehensive battery of tests.
      • A diagnosis must be based on the aggregate of test results, history and level of current functioning. It is not acceptable to base a diagnosis on only one or two subtests.
      • Objective evidence of a substantial limitation to learning must be presented.
      • Tests must be appropriately normed for the age of the patient and must be administered in the designated standardized manner.
      • Minimally, the domains to be addressed in the psychoeducational or neuropsychological evaluation should include assessment of:
        1. Cognitive Functioning: A complete cognitive assessment is essential with all subtests and standard scores reported. Acceptable measures include but are not limited to: Wechsler Adult Intelligence Scale-III (WAIS-III); Woodcock Johnson Psychoeducational Battery-III (WJ-III): Tests of Cognitive Ability; Kaufman Adolescent and Adult Intelligence Test.
        2. Achievement: A comprehensive achievement battery with all subtests and standard scores is essential. The battery must include current levels of academic functioning in relevant areas such as reading (decoding and comprehension) and mathematics. Acceptable instruments include, but are not limited to, the Woodcock-Johnson Psychoeducational Battery - Revised: Tests of Achievement (WJ-III); The Scholastic Abilities Test for Adults (SATA); Woodcock Reading Mastery Tests-III. Specific achievement tests are useful instruments when administered under standardized conditions and when interpreted within the context of other diagnostic information. The Wide Range Achievement Test-3 (WRAT-3) and the Nelson-Denny Reading Test are not comprehensive diagnostic measures of achievement and therefore neither is acceptable if used as the sole measure of achievement.
        3. Information Processing: Specific areas of information processing (e.g., short- and long-term memory, sequential memory, auditory and visual perception/processing, auditory and phonological awareness, processing speed, executive functioning, motor ability) must be assessed. Acceptable measures include, but are not limited to, the Detroit Tests of Learning Aptitude - Adult (DTLA-A), Wechsler Memory Scale-III (WMS-III), information from the Woodcock Johnson Psychoeducational Battery-III Tests of Cognitive Ability, as well as other relevant instruments that may be used to address these areas.
        4. Other Assessment Measures: Other formal assessment measures or nonstandard measures and informal assessment procedures or observations may be integrated with the above instruments to help support a differential diagnosis or to disentangle the learning disability from co-existing neurological and/or psychiatric issues. In addition to standardized test batteries, nonstandardized measures and informal assessment procedures may be helpful in determining performance across a variety of domains.
4. Actual test scores must be provided (age-based standard scores where available) as well as identification of norms used to interpret the data. Evaluators should use the most recent form of tests and should identify the specific test form as well as the norms used to compute scores. It is helpful to list all test data in a score summary sheet appended to the evaluation.
5. Records of academic history should be provided. Because learning disabilities are most commonly manifested during childhood, relevant records detailing learning processes and difficulties in elementary, secondary and postsecondary education should be included. Such records as grade reports, transcripts, teachers' comments and the like will serve to substantiate self-reported academic difficulties in the past and present.
6. A differential diagnosis must be reviewed and various possible alternative causes for the identified problems in academic achievement should be ruled out. The evaluation should address key constructs underlying the concept of learning disabilities and provide clear and specific evidence of the information processing deficit(s) and how these deficits currently impair the individual's ability to learn. No single test or subtest is a sufficient basis for a diagnosis. The differential diagnosis must demonstrate that:
   1. Significant difficulties persist in the acquisition and use of listening, speaking, reading, writing or reasoning skills.
   2. The problems being experienced are not primarily due to lack of exposure to the behaviors needed for academic learning or to an inadequate match between the individual's ability and the instructional demands.
7. A clinical summary must be provided. A well-written diagnostic summary based on a comprehensive evaluative process is a necessary component of the report. Assessment instruments and the data they provide do not diagnose; rather, they provide important data that must be integrated with background information, historical information and current functioning. It is essential then that the evaluator integrates all information gathered in a well-developed clinical summary. The following elements must be included in the clinical summary:
   1. Demonstration of the evaluators having ruled out alternative explanations for the identified academic problems as a result of poor education, poor motivation and/or study skills, emotional problems, attentional problems and cultural or language differences;
   2. Indication of how patterns in cognitive ability, achievement and information processing are used to determine the presence of a learning disability;
   3. Indication of the substantial limitation to learning presented by the learning disability and the degree to which it impacts the individual in the context of the CPE; and
   4. Indication as to why specific accommodations are needed and how the effects of the specific disability are mediated by the recommended accommodation(s).
8. Each accommodation recommended by the evaluator must include a rationale. The evaluator must describe the impact the diagnosed learning disability has on a specific major life activity as well as the degree of significance of this impact on the individual. The diagnostic report must include specific recommendations for accommodations and a detailed explanation as to why each accommodation is recommended. Recommendations must be tied to specific diagnostic test results or clinical observations. The documentation should include any record of prior accommodation or auxiliary aids, including any information about specific conditions under which the accommodations were used and whether or not they were effective. However, a prior history of accommodation, without demonstration of a current need, does not in and of itself warrant the provision of a like accommodation. If no prior accommodation(s) has been provided, the qualified professional expert should include a detailed explanation as to why no accommodation(s) was used in the past and why accommodation(s) is needed at this time.
9. Problems such as test anxiety, English as a second language in and of itself, slow reading without an identified underlying cognitive deficit or failure to achieve a desired academic outcome are not learning disabilities and, therefore, are not covered under the ADA.

Guidelines for Documenting Attention-Deficit/Hyperactivity Disorder (ADHD)—For those applicants submitting a request for accommodations based specifically on Attention-Deficit/Hyperactivity Disorder (ADHD), the following additional information is provided to clarify the documentation process:

1. The evaluation must be conducted by a qualified diagnostician. Professionals conducting assessments and rendering diagnoses of ADHD must be qualified to do so. Comprehensive training in the differential diagnosis of ADHD and other psychiatric disorders and direct experience in diagnosis and treatment of adults is necessary. The evaluator's name, title and professional credentials, including information about license or certification as well as the area of specialization, employment and state in which the individual practices should be clearly stated in the documentation.
2. Testing/assessment must be current. The determination of whether an individual is "significantly limited" in functioning is based on assessment of the current impact of the impairment on the CPE (see General Guidelines for Documenting Disabilities).
3. Documentation necessary to substantiate the ADHD must be comprehensive. Because ADHD is, by definition, first exhibited in childhood (although it may not have been formally diagnosed) and in more than one setting, objective, relevant, historical information is essential. Information verifying a chronic course of ADHD symptoms from childhood through adolescence to adulthood, such as educational transcripts, report cards, teacher comments, tutoring evaluations, job assessments, and the like are necessary.
   1. The evaluator is expected to review and discuss DSM-IV diagnostic criteria for ADHD and describe the extent to which the patient meets these criteria. The report must include information about the specific symptoms exhibited and document that the patient meets criteria for long-standing history, impairment, and pervasiveness.
   2. A history of the individual's presenting symptoms must be provided, including evidence of ongoing impulsive/hyperactive or inattentive behaviors (as specified in DSM-IV) that significantly impair functioning in two or more settings.
   3. The information collected by the evaluator must consist of more than a self-report. Information from third party sources is critical in the diagnosis of adult ADHD. Information gathered in the diagnostic interview and reported in the evaluation should include, but not necessarily be limited to, the following:
      • History of presenting attentional symptoms, including evidence of ongoing impulsive/hyperactive or inattentive behavior that has significantly impaired functioning over time;
      • Developmental history;
      • Family history for presence of ADHD and other educational, learning, physical, or psychological difficulties deemed relevant by the examiner;
      • Relevant medical and medication history, including the absence of a medical basis for the symptoms being evaluated;
      • Relevant psychosocial history and any relevant interventions;
      • A thorough academic history of elementary, secondary, and postsecondary education;
      • Review of psychoeducational test reports to determine if a pattern of strengths or weaknesses is supportive of attention or learning problems;
      • Evidence of impairment in several life settings (home, school, work, etc) and evidence that the disorder significantly restricts one or more major life activities.
      • Relevant employment history;
      • Description of current functional limitations relative to a clinical practice setting and to the CPE in particular that are presumably a direct result of the described problems with attention;
      • A discussion of the differential diagnosis, including alternative or co-existing mood, behavioral, neurological, or personality disorders that may confound the diagnosis of ADHD; and
      • Exploration of possible alternative diagnoses that may mimic ADHD.
4. Relevant assessment batteries must be described. A neuropsychological or psychoeducational assessment may be necessary in order to determine the individual's pattern of strengths or weaknesses and to determine whether there are patterns supportive of attention problems. Test scores or subtest scores alone should not be used as the sole basis for the diagnostic decision. Scores from subtests on the Wechsler Adult Intelligence Scale - III (WAIS - III), measures of memory function, or attention or tracking tests or continuous performance tests do not in and of themselves establish the presence or absence of ADHD. They may, however, be useful as one part of the process in developing clinical hypotheses. Checklists or surveys can serve to supplement the diagnostic profile but by themselves are not adequate for the diagnosis of ADHD. When testing is used, age-based standard scores must be provided for all normed measures.
5. Identification of DSM-IV criteria. A diagnostic report must include a review of the DSM-IV criteria for ADHD both currently and retrospectively and specify which symptoms are present (see DSM-IV for specific criteria). According to DSM-IV, "the essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development." Other criteria include:
   1. Symptoms of hyperactivity-impulsivity or inattention that cause impairment that were present in childhood.
   2. Current symptoms that have been present for at least the past six months.
   3. Impairment from the symptoms present in two or more settings (school, work, home, etc).
6. Documentation must include a specific diagnosis. The report must include a specific diagnosis of ADHD based on the DSM-IV diagnostic criteria. Individuals who report problems with organization, test anxiety, memory, and concentration only on a situational basis do not fit the prescribed diagnostic criteria for ADHD. Given that many individuals benefit from prescribed medications and therapies, a positive response to medication by itself is not supportive of a diagnosis, nor does the use of medication in and of itself either support or negate the need for accommodation.
7. A clinical summary must be provided. A well-written diagnostic summary based on a comprehensive evaluative process is a necessary component of the assessment. The clinical summary must include:
   1. Demonstration of the evaluators having ruled out alternative explanations for inattentiveness, impulsivity, and/or hyperactivity as a result of psychological or medical disorders or non-cognitive factors;
   2. Indication of how patterns of inattentiveness, impulsivity, and/or hyperactivity across the life span and across settings are used to determine the presence of ADHD;
   3. Indication of the substantial limitation to learning presented by ADHD and the degree to which it impacts the individual in the context for which accommodations are being requested (eg, impact on the CPE); and
   4. Indication as to why specific accommodations are needed for the CPE and how the effects of ADHD symptoms, as designated by the DSM-IV, are mediated by the accommodation(s).
8. Each accommodation recommended by the evaluator must include a rationale. The evaluator must describe the impact of ADHD (if one exists) on a specific major life activity as well as the degree of significance of this impact on the individual. The diagnostic report must include specific recommendations for accommodations. A detailed explanation must be provided as to why each accommodation is recommended and should be correlated with specific identified functional limitations. Prior documentation may have been useful in determining appropriate services in the past. However, documentation should validate the need for accommodation based on the individual's current level of functioning. The documentation should include any record of prior accommodation or auxiliary aid, including information about specific conditions under which the accommodation was used (eg, standardized testing, final exams, etc). However, a prior history of accommodation without demonstration of a current need does not in itself warrant the provision of a similar accommodation. If no prior accommodation has been provided, the qualified professional and/or individual being evaluated should include a detailed explanation as to why no accommodation was used in the past and why accommodation is needed at this time.
9. Because of the challenge of distinguishing ADHD from normal developmental patterns and behaviors of adults, including procrastination, disorganization, distractibility, restlessness, boredom, academic underachievement or failure, low self-esteem, and chronic tardiness or inattendance, a multifaceted evaluation must address the intensity and frequency of the symptoms and whether these behaviors constitute impairment in a major life activity.

Confidentiality—Except where necessary to make a determination of appropriate accommodations, the ECFVG does not disclose names of applicants with disabilities or information concerning the application or accompanying documentation. In that event, such information shall be disclosed only to outside experts and other consultants. Entities receiving verification of certification are not advised of any accommodations provided to the subject candidate.