Exam Accommodations for a Chronic Illness: UK and US
How exam access arrangements work for a chronic illness in the UK and testing accommodations in the US, who decides them and what evidence to prepare.
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You have a school, college or university exam coming up, and a chronic condition can change how you sit it. In the UK that support is called an exam access arrangement, and in the US a testing accommodation. You can keep a dated record of the days your condition disrupts study on paper or in Sam's symptom diary. Each symptom day and sick day carries a date, and the monthly report marks symptom days on a calendar, so you bring months of your own notes instead of memory.
This text is general information, not legal advice. Every exam body has its own rules, and your case is individual. In the UK, start with the SENCO or exams officer at school or college, or the disability and wellbeing service at university. In the US, start with the school 504 or SSD coordinator, or the university disability office. In Great Britain, the Equality Advisory and Support Service can advise if you disagree with a decision; in the US, a disability rights lawyer can.
What are exam access arrangements and testing accommodations?
Exam accommodations change how you sit an exam, such as extra time or rest breaks, not what is marked. With a chronic illness you can get them when it affects how you work in that exam. In the UK school and college exams go through JCQ; in the US the testing body or disability office decides.
The idea is the same in both countries: an exam should let you show what you know, and a condition should not get in the way of that.
In England, Scotland and Wales, disabled students are entitled to reasonable adjustments under the Equality Act 2010 (Northern Ireland has its own disability law). The exam boards run these as access arrangements through the Joint Council for Qualifications (JCQ). A reasonable adjustment must not change what is assessed or undermine the integrity of the assessment.
In the US, the Americans with Disabilities Act (ADA) requires testing entities to offer exams in a way accessible to people with disabilities. The Department of Justice calls testing accommodations changes that let a person with a disability demonstrate their true aptitude.
Where does a chronic condition fit?
A chronic diagnosis alone does not decide it. What matters is how your condition limits a life activity, such as reading, writing, concentrating or sitting. The same is true in the UK, where the definition of disability looks at the effect of the condition.
A condition that causes pain, fatigue, poor concentration or the need for breaks can fit this. So can side effects of treatment. In the US, the effect is judged against most people in the general population, and a history of academic success does not mean you have no disability that needs testing accommodations.
Who decides in the UK?
For school and college exams, your school or college is responsible for identifying the arrangements you need. That work is usually led by the SENCO, based on a picture of your need and how you normally work.
For some arrangements, like 25% extra time, the centre must gather evidence and apply to the exam boards through the JCQ online system. For others, like supervised rest breaks, the centre can provide the arrangement without applying. Modified papers and other specialist support have their own routes and deadlines.
At university, the position is different. Under the Equality Act, your university must make reasonable adjustments so you are not at a substantial disadvantage. You usually register with the disability and wellbeing service, which assesses your needs and arranges support. In England, the Disabled Students' Allowance (DSA) can fund study-related costs of a long-term illness, and it does not have to be repaid. Scotland, Wales and Northern Ireland run their own schemes.
Who decides in the US?
Two layers matter. For high-stakes tests, the testing body decides. College Board runs every SAT and AP accommodation through its Services for Students with Disabilities (SSD), and approval is required before you take the test with accommodations. ACT has its own request process.
For the ACT, a copy of a current IEP or Section 504 plan that already includes the accommodation is enough for those accommodations. For the SAT, your school usually enters the plan into College Board's SSD Online, and most such requests are approved without further documents. If you do not have one, you submit a letter or report from a licensed, qualified professional that explains your impairment and the accommodation you need.
At university, the disability services office arranges accommodations under the ADA and Section 504. You register with that office, provide documentation, and agree which supports you will use.
What can you ask for, and what can you not?
Common examples are extra time, supervised rest breaks, a smaller or quieter room, modified or enlarged papers, a screen reader or scribe, and permission to bring medication into the exam.
The limit matters. An accommodation can help you show knowledge you already have. It cannot fund a change to what the exam measures. A request for extra time will usually be judged against whether the exam is testing skill at working under time pressure, and whether your condition affects that. This is why the evidence must link your condition to the specific exam task.
What documentation helps an application?
Keep it measured. The US Department of Justice says documentation must be reasonable and limited to the need for the arrangement. A current IEP or 504 plan, or a letter from a qualified professional, is often enough. Proof of past accommodations in similar settings usually carries over to a new test.
In the UK, the school builds an evidence of need. That can include how you work in class, past support you received, and a medical note. A record from your own side supports this process.
Your own dated notes help your doctor or counsellor write the specific letter. Record which dates your condition affected concentration, reading, writing, sitting or rest, and how long the effect lasted. Bring that to the appointment. The doctor visit checklist for a chronic condition helps you prepare.
What if your request is turned down?
Read the reason given. Look for whether the decision was about the evidence or about the nature of the exam. If the evidence was too general, a more specific note from your doctor or specialist can help.
You can usually ask the body to reconsider, and in the US a denial may be appealable under the disability office's process. In either country, a student adviser or a lawyer who knows exam law can look at the decision. For the longer picture of your rights at work later, see our guide to reasonable adjustments at work.
What should you plan for on exam day?
Ask in advance where you can take medication and whether you may have water, snacks or a phone for medical alerts. Confirm who to tell if you need a break or feel unwell during the exam.
In a medical emergency on exam day, call your local emergency number (112 in the EU, 999 in the UK, 911 in the US). Do not leave the building without telling an invigilator, and keep any evidence of what happened in case it matters later.
Keep a dated symptom record to support the accommodation
You go to the request with months of dates instead of estimates, and your doctor or counsellor has real detail for a specific letter.
- Instead of memory: in Sam's symptom diary, each symptom day and sick day carries a date, and the monthly report marks symptom days on a calendar.
- Instead of loose papers: a sick day can carry a doctor's note or test photo, and the Health Vault holds letters and assessments in your own copy.
- Instead of going through it alone: if a parent or partner helps you, Friends & Family sharing lets them see the areas you choose, read-only and as a refreshed snapshot, if they use Sam too.
Sam fills in no forms and decides no application. The note, and the decision, stay with your doctor, counsellor and the exam body.
Try Sam HealthSam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.
General information, not legal advice. Laws, deadlines and agency practice change, and your case may differ. Before applications, deadlines and conversations with employers, insurers or agencies, get advice from an adviser or lawyer.
Related reading
- Doctor visit checklist for a chronic condition
- Reasonable adjustments at work for a chronic illness
- Must you tell your employer about a chronic illness?
- Phased return to work after a chronic illness
- Chronic Illness: When to Tell Your Partner and Friends
Sources
Updated: October 2026
- GOV.UK (Ofqual): Regulatory report: Access arrangements, including 25% extra time (published 27 November 2025)
- JCQ: Access arrangements and reasonable adjustments
- GOV.UK: Disabled Students' Allowance (DSA)
- Disability Rights UK: Adjustments for disabled students
- U.S. Department of Justice: ADA Requirements: Testing Accommodations (last updated 28 February 2020)
- ACT: Policy for requesting accommodations for the ACT test
- College Board, Services for Students with Disabilities: Accommodations on College Board exams
More on recording and taking it along
Frequently Asked Questions
What is an exam accommodation for a chronic illness?+
A change to how you sit an exam, so a disability or chronic condition does not stop you showing what you know. In the UK it is often called an access arrangement, and in the US a testing accommodation. The standard is not lowered; the conditions change.
Can I get extra time in exams with a chronic condition?+
Often yes, but it is decided case by case. In the UK up to 25% extra time is the most common exam-board approved arrangement, and in the US extended time is a frequent accommodation under the ADA. The request must show that your condition affects how you work in that exam.
Who decides whether I get accommodations in the UK?+
For school and college exams, your school or college applies to the exam boards through the Joint Council for Qualifications (JCQ), usually led by the SENCO. For some arrangements, like supervised rest breaks, the centre can provide them without applying. At university, your disability service assesses and arranges reasonable adjustments.
Who decides whether I get accommodations in the US?+
For the SAT, ACT and AP exams, the testing body approves. College Board via its Services for Students with Disabilities and ACT both require a request with documentation. At university, the disability services office arranges accommodations under the ADA and Section 504.
What documentation do I need?+
Documentation should be reasonable and limited to the need for the arrangement. A current US IEP or Section 504 plan is often enough for the ACT and for most SAT requests; otherwise a letter or report from a qualified professional works. In the UK, the school gathers evidence of need based on how you normally work.
Does an accommodation change my exam grade?+
No. An accommodation changes the conditions of the exam, not the standard used to mark it. The reasonable adjustment must not change what is being assessed.
How can a symptom record help my application?+
It gives dates and detail instead of estimates. Recording which days your condition affects concentration, reading, writing or rest, and how long the effect lasts, helps your doctor or counsellor write a specific note. It supports the application; it does not replace the decision.