Start Early
You do not need to wait until your school makes you eligible to take COMLEX Level 1 to begin the accommodation process.
Once you have completed your first year of osteopathic medical school, you are eligible to submit an accommodation request to the NBOME. If your school has not yet certified your Level 1 eligibility, you will need to include proof that you completed your first year, such as an unofficial transcript or a signed letter from a school official.
Starting early is strongly recommended. NBOME says a complete application is generally reviewed within approximately 75 days, but its current instructions say review can take 60–75 days and as many as 90 days during peak application periods. Additional documentation can also extend the process.
Practical tip: If you know you will likely need accommodations, consider beginning to collect records and speak with your providers during your first year. Then, once you have completed Year 1 and become eligible to apply, you can submit without having to assemble years of records at the last minute.
Where Do I Apply?
Start with the official NBOME Test Accommodations page:
The page contains the application, detailed instructions, forms for students who previously received COMLEX accommodations, and specialized forms for certain requests. NBOME prefers applications and supporting documentation to be submitted by email to testacc@nbome.org.
If you submit by email, NBOME instructs applicants to submit documents as PDFs without password protection. Keep your own complete copy of everything you submit.
What Will I Need?
Think of the application as answering two separate questions: What barrier does your disability create under standard testing conditions, and why does the accommodation you are requesting address that barrier?
Depending on your circumstances, your application may include:
- The completed and signed NBOME accommodation application.
- A personal narrative describing your disability, its functional effects in daily life and testing, and why the requested accommodation is necessary.
- Current and historical evaluations or medical documentation from qualified professionals.
- Documentation of the evaluator's qualifications.
- Records of previous accommodations and standardized testing, when applicable.
- Verification from your medical school if you have received accommodations there.
NBOME specifically asks applicants to describe how the impairment limits relevant major life activities compared with most people in the general population and how the requested accommodation makes the examination accessible. If you have already received accommodations in medical school, the application includes a Verification of Test Accommodations for your dean or the dean's representative to complete.
Your Documentation Should Explain More Than the Diagnosis
A diagnosis by itself does not explain why a particular testing accommodation is needed. Ask your evaluator or treating professional to describe your actual functional limitations, how those limitations affect you under standardized testing conditions, and why the specific accommodation you are requesting addresses those limitations.
For example, instead of documentation simply saying that a student has a particular condition and "would benefit from additional breaks," useful documentation should explain the relevant symptoms or limitations, what happens during a lengthy standardized examination, and why additional breaks are necessary to make the examination accessible.
It is also worth reviewing your entire packet for consistency before submitting it. Dates, diagnoses, accommodation history, functional limitations, and the accommodations being requested should not inadvertently contradict one another across your application, personal narrative, school verification, and provider documentation.
Don't Forget Older Records
Do not assume that only your newest evaluation matters. NBOME asks for relevant current and historical documentation, including educational/developmental records and standardized-test score reports with and without accommodations when applicable.
A good first step is to make a folder early in medical school containing relevant evaluations, accommodation letters, prior standardized-testing records, school accommodation documentation, and pertinent medical records. That can make the eventual application much easier to assemble.
If You Already Receive Medical-School Accommodations
Contact your medical school's Disability/Accessibility Services office early, rather than waiting until you are ready to submit. They can help you obtain your school's accommodation history and identify the appropriate dean or representative to complete NBOME's school verification.
Keep in mind that receiving accommodations from your medical school does not automatically mean NBOME will grant the same accommodations for COMLEX-USA. NBOME conducts its own review of the documentation and requested accommodations.
After You Submit
Watch for confirmation that NBOME received your application. The current NBOME website specifically says to follow up if you have not received a confirmation email within five business days.
Try not to build your academic schedule around the assumption that a decision will arrive on the earliest possible date. Additional documentation can extend the process, and an unfavorable decision may require additional time to address.
You can schedule a standard, non-accommodated examination while an accommodation request is pending. However, there is an important catch: if accommodations are later approved, you will have to cancel the standard appointment and schedule an accommodated examination to use them. If you actually take the standard examination while the request is pending, NBOME considers the accommodation request withdrawn.
What If My Request Is Denied?
A denial does not necessarily end the process. NBOME permits one reconsideration per COMLEX-USA examination level, but reconsideration requires new and compelling information or documentation and a written explanation of why the decision should be reconsidered. Simply resending the same materials is not sufficient. Reconsideration itself may take approximately 60–75 days.
If you receive a denial, read the decision carefully before responding. Identify exactly what NBOME believed was missing or insufficient and focus any reconsideration on addressing those specific issues.
What About Level 2-CE and Level 3?
An earlier COMLEX accommodation approval does not mean you can simply assume it will automatically carry forward. For a subsequent COMLEX-USA examination, NBOME requires another application. However, if you are requesting the same accommodations that NBOME previously approved, you generally do not need to resubmit the supporting documentation. If you request additional accommodations, you need to provide new documentation supporting the additional request.
The NBOME accommodations page provides a separate form specifically for candidates who have already received COMLEX-USA accommodations.
Quick COMLEX Accommodation Checklist
Before you hit send, ask yourself if you have everything you need:
- My completed, signed NBOME Request for Test Accommodations application
- My personal narrative (explaining condition → functional limitation → testing barrier → requested accommodation)
- Provider evaluation/documentation (explaining functional limitations, not just naming a diagnosis)
- My evaluator's qualifications (CV or similar documentation)
- Medical-school accommodation verification (if applicable, completed by the dean or representative)
- Relevant historical records (educational/developmental, previous evaluations, medical history)
- Previous standardized-test records (score reports with and without accommodations, e.g., MCAT, ACT)
- If applying before my school makes me Level 1 eligible: Proof that I completed Year 1 (unofficial transcript or letter on school letterhead)
Save a copy of the entire packet and submit it well before your anticipated test date.
For questions specifically about a test-accommodation application, NBOME lists testacc@nbome.org as the accommodation contact. General COMLEX questions can go to NBOME Client Services.