Request for Examination Accommodation

Submitted by kzachary on Wed, 07/09/2025 - 08:50

Please use this form to request a special accommodation to take the NC Well Contractors Certification Examination due to a medical condition. We'll reach out to you for supporting documentation from a physician, as required by North Carolina law (15A NCAC 27.0410(b) (PDF)).

Submit this completed request with your application for certification as a well contractor and with any request for an out-of-cycle examination.

Indicates required field

Last Name

First Name

Email Address

Phone

Desired Level of Certification

Special Accommodation Requested:

Oral Exam

(Please also complete a request for an out-of-cycle exam.)

Wheelchair Accessible Location

Other

Please detail other accommodation requested

Electronic Signature (type your name)

Date

This question is for testing whether or not you are a human