Requesting NBCOT® Exam Accommodations

Katherine M. Post, OT, PhD, OTR, FAOTA

This article was updated in January 2024.

Note: Although OT Student Pulse articles are written by and for students, we made an exception to ensure that as many students as possible have access to this information.

If you are an OT or OTA student who has a documented disability, then you may be eligible to receive testing accommodations (TAs) for the National Board for Certification in Occupational Therapy (NBCOT®) examination. Being successful on your TA application, however, requires you to plan ahead and think carefully about how you will request and use your accommodations effectively. With the right documentation, accommodations to how the test is administered are generally considered reasonable if they make the test more accessible but still preserve the integrity, content, and rigor of the exam.

Applying for testing accommodations

Laying the groundwork to take your exam with the right accommodations should start while you are still at your campus, before beginning your Level II fieldwork. Even though you will not apply for accommodations until you submit your NBCOT exam application (around the time you finish fieldwork), assembling the documentation might take several months.

Learn all you can about the NBCOT exam in order to identify what accommodations to request, submit your application, and use your approved accommodations successfully. Start by downloading these resources and reading them carefully:

In addition, be sure to watch or interact with:

  • The OTR® or COTA® Exam Tutorial demonstrates the test format and lets you practice selecting answers, navigating through the exam, and using universal design features like flagging questions, highlighting, striking out answers, and changing screen and font contrast and color.
  • Pearson VUE's What to Expect When Testing With Pearson VUE video shows check-in and break procedures, and their Take a Photo Tour page shows what a typical testing center looks like.

Your OT faculty are familiar with the exam and can provide guidance and resources, and your college or university’s Office of Disability Services can help if they understand the format and requirements of the exam and its application process.

NBCOT uses two main criteria for granting testing accommodations: identifying whether you have a qualifying disability, and whether the accommodations you request are reasonable and appropriate. Both criteria should be familiar from your experiences in school unless your condition or diagnosis is fairly recent. You must provide NBCOT with documentation of your disability and what accommodations you need to perform optimally on the NBCOT exam. If you have not previously been granted TAs, explain why they were not given (or requested) in the past and why they are needed now.

One additional note is that NBCOT will accommodate test takers who are nursing by providing a break for pumping or expressing breast milk during the exam. See page 5 of the Testing Accommodations Handbook for further information about how to request and schedule this.

Types of testing accommodations

Your accommodations are unique and should be specific to your needs. What accommodations have helped in your academic career, even if you did not use them all the time? What aspects of NBCOT’s standard testing conditions would interfere with your ability to complete the test, and what accommodations would help address any barriers?

Access to the testing center and check-in procedures. As public accommodations, testing centers should be physically accessible to people with mobility impairments, both indoors and out, and mobility devices are on the list of pre-approved items. If you have concerns that a vision or hearing impairment may make checking in difficult, ask about arrangements when you schedule your test appointment. If you will need to refrigerate medication or access any medical devices on the pre-approved list during the test, confirm ahead of time that this will be allowed.

The setting for test-taking. Pearson VUE administers exams for many clients besides NBCOT, so you will be testing with people starting and finishing their exams throughout your test time. As shown in the Pearson VUE video and photos, computers are set up in study carrels in a common room, with partial visual barriers between stations and some buffering of sound. Test takers may wear ear protectors provided by Pearson VUE or bring their own foam earplugs to help block out noises in the room.

If your disability affects your needs for seating, desk height, lighting, noise, or other environmental conditions, consider what options might be helpful. For example, you may request a standing or adjustable-height desk, or a separate testing room where you can alternate sitting and standing and/or control the lighting. A separate room is useful if you perform better by reading questions aloud, you use assistive technologies with audio output, or you need a person to read questions to you. Separate rooms are frequently requested to help reduce distractions; manage attention, anxiety, or certain medical conditions; or accommodate people accompanied by a service animal.

Computer access: Computer-based testing provides opportunities for everyone to use the universal design features described in the NBCOT Exam Tutorials. However, barriers may still exist when reading and answering questions and navigating from question to question. The Pearson VUE website does not list available assistive technologies, but be sure to include any assistive technologies that you have used at your institution on your application. This would include text-to-screen readers and larger monitors for test takers with vision impairments or reading disabilities; ergonomic keyboards, trackballs, or head-controlled mice to help navigate pages and select responses; personal assistance to read questions, input responses, or help keep track of the exam time; or extra scrap paper to accommodate working memory or mental processing challenges.

Length of time for testing. Extending the exam time to 6 or 8 hours can be helpful to many test takers with disabilities. More time allows you to read more slowly and process information more thoroughly, read questions multiple times, apply memory retrieval strategies, or use approved assistive technologies. Extended time allows more breaks to refocus your attention, respond to medical needs, change your position, recover from fatigue, or utilize anxiety management techniques. You may take “breaks in place” to close your eyes, practice deep breathing, or, if in a separate room, stand up and stretch. Breaks taken outside of the testing room require extra time for checking in and out, but some test takers have received the accommodation of “flexible breaks,” which are taken with the clock stopped.

Exam preparation strategies

Most students spend a month or two preparing for the NBCOT exam, but how long it will take you depends on your study skills, habits, and routines. If it takes you longer to read and retain information, then you should consider taking longer to prepare. You may want to wait to schedule your exam until you have made some progress on your study plan, though knowing the date of your test may serve as a motivator to stay on track.

Before you can contact Pearson VUE to schedule your exam, you must have your Authorization to Test (ATT) With Testing Accommodations letter, which will be available in your MyNBCOT account. Follow any instructions in your notice about coordinating your accommodations with Pearson VUE.

Preparing for the NBCOT exam requires both strengthening your content knowledge and clinical reasoning skills, and learning and practicing effective test-taking strategies while utilizing your approved accommodations. Online and print resources for structuring and implementing a study plan are available from NBCOT, AOTA, and several other sources. Make sure that any resources you utilize are reliable, and be cautious about hidden costs. Your OT faculty can help identify well-known, reputable sources of information, and your school may have coaching or tutoring services available to you.

Continue to use your textbooks and class notes from your academic program when reviewing study materials from outside sources. This will tap into your memories of reading and hearing information initially and help you scaffold your knowledge. Use all your senses as you actively engage with content by taking notes or making flashcards, reading out loud, and acting out motions to enhance memory retention and retrieval.

Practice tests prepare you for the exam in several ways:

  • If detailed results and feedback are available, a practice test can reveal your stronger and weaker content areas, and reviewing the rationale behind both correct and incorrect answers can help you understand how questions are written. Look closely before purchasing practice tests to see if you will get item-by-item results or simply scores in the four domains of the exam.
  • Simulating actual test conditions during practice tests accustoms you to what the real exam might feel like. Practice with your approved accommodations or assistive technologies so you are proficient and comfortable with their use. If you plan to wear noise-cancelling headphones and a COVID-19 face mask during the official exam, then wear them during practice tests.
  • Practice tests allow you to work on pacing yourself so you can read and answer questions within the allowed timeframe, and help increase your endurance for the length of test, practice strategies for refreshing yourself, and anticipate when to take breaks.

As you get closer to the exam, it is natural to be nervous, so take care of yourself and find ways to stay as calm and focused as possible. You will feel more in control if you rehearse the exam day a week or so before your actual test date. Drive to the testing center to familiarize yourself with the route and traffic along the way. Think about your timing of eating, drinking, and bathroom use in relation to your test schedule. Shift your bedtime routine so you’re accustomed to getting up in time for your test appointment. Watch the Pearson VUE video again to review the check-in procedures. Gather the materials you must take to the exam with you, including your ATT letter from NBCOT and required forms of identification. Be prepared to leave prohibited items (e.g., cellphone, watch, most jewelry) at home or in your car.

The day of the exam

Once your exam day has arrived, you should know what to expect and be able to use your best strategies to demonstrate your knowledge and skills. When you check in, present your ATT letter with your approved accommodations and confirm that they are provided as written. Once at your testing station, take a few minutes to familiarize yourself with the space. Take the untimed tutorial and make sure any assistive technologies are working before you begin.

If there are computer malfunctions during the exam, including with any approved assistive technologies, alert the testing center staff immediately. The NBCOT Certification Exam Handbook provides detailed instructions on how to file a report if you feel the problem affected your test performance or completion, but you must act within 24 hours after the test.

You will not know the results of your exam until the next score release date, so take the next few days to celebrate yourself and what you have accomplished so far. You are the best judge of when and where to access your results and how you wish to share your news with your network. Although there is a lower first-time pass rate for individuals with disabilities than for those without disabilities, you can still be successful because you prepared well. And if you should need to retake the exam, spend time thinking through what went well and what was most challenging about the experience, and reach out to someone who can help you identify strategies to perform at a higher level on your next exam. Remember, with more than 10,000 OT and OTA graduates taking NBCOT exams each year, you are not alone at any phase of this journey.

Katherine M. Post, OT, PhD, OTR, FAOTA, is Professor Emeritus in the Springfield College Occupational Therapy Department in Springfield, Massachusetts. She has more than 30 years of experience teaching neuroscience, anatomy, neurorehabilitation, assistive technology, and research courses, with clinical experiences working in early intervention, with school age children with severe disabilities, and with adults with neurological conditions. She has a doctorate in special education and has written about universal design for learning, seating and positioning, and working with students with disabilities.

Advertisement