Form BFS-856 "Fire Fighter Exam Accommodation Request" - Michigan

What Is Form BFS-856?

This is a legal form that was released by the Michigan Department of Licensing and Regulatory Affairs - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 26, 2020;
  • The latest edition provided by the Michigan Department of Licensing and Regulatory Affairs;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form BFS-856 by clicking the link below or browse more documents and templates provided by the Michigan Department of Licensing and Regulatory Affairs.

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Download Form BFS-856 "Fire Fighter Exam Accommodation Request" - Michigan

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Fire Fighter Exam Accommodation Request
Michigan Department of Licensing and Regulatory Affairs
Bureau of Fire Services
Fire Fighter Training Division
2407 N. Grand River
P.O. Box 30700
Lansing, MI 48909
(517) 241-8847
To Be Completed By Applicant
The information or documentation regarding your disability and your need for an accommodation
in testing will be considered strictly confidential. This information will not be shared with any
outside source without your written consent.
Name:
SMOKE PIN:
Accommodations are requested for
the following examination:
Exam Date:
Location:
I am requesting the following accommodation be provided:
Reader as an accommodation for a learning disability.
A separate testing area.
Note: The Firefighter I & II exam is not a timed examination
Other:
Applicant Signature (below):
Date:
Documentation of Disability Related Needs
Note: To be completed by an appropriate professional (education professional, doctor,
psychologist and/or psychiatrist) certifying your disability requires the requested exam
accommodation.
I have known _________________________ since _______________________ in my capacity
as a _______________________________________________________________________.
The applicant has discussed the nature of the test to be administered, it is my opinion that due
to this applicant's disability, he/she should be accommodated for those items checked above.
Please attach an explanation of the applicant's disability and related medical facts to
support the accommodations requested.
Signature:
Date:
Title:
License Number (If applicable):
Please submit the completed form and attached documentation to:
LARA-BFS-SMOKE@michigan.gov
BFS-856 (Rev. 10/26/2020)
Fire Fighter Exam Accommodation Request
Michigan Department of Licensing and Regulatory Affairs
Bureau of Fire Services
Fire Fighter Training Division
2407 N. Grand River
P.O. Box 30700
Lansing, MI 48909
(517) 241-8847
To Be Completed By Applicant
The information or documentation regarding your disability and your need for an accommodation
in testing will be considered strictly confidential. This information will not be shared with any
outside source without your written consent.
Name:
SMOKE PIN:
Accommodations are requested for
the following examination:
Exam Date:
Location:
I am requesting the following accommodation be provided:
Reader as an accommodation for a learning disability.
A separate testing area.
Note: The Firefighter I & II exam is not a timed examination
Other:
Applicant Signature (below):
Date:
Documentation of Disability Related Needs
Note: To be completed by an appropriate professional (education professional, doctor,
psychologist and/or psychiatrist) certifying your disability requires the requested exam
accommodation.
I have known _________________________ since _______________________ in my capacity
as a _______________________________________________________________________.
The applicant has discussed the nature of the test to be administered, it is my opinion that due
to this applicant's disability, he/she should be accommodated for those items checked above.
Please attach an explanation of the applicant's disability and related medical facts to
support the accommodations requested.
Signature:
Date:
Title:
License Number (If applicable):
Please submit the completed form and attached documentation to:
LARA-BFS-SMOKE@michigan.gov
BFS-856 (Rev. 10/26/2020)