Orthopedic Specialty
Become Orthopedic Specialty Certified
A Specialty Credential That Underscores Your Specialty—Orthopedics.
The BOC Orthopedic Specialty Certification (orthopedic specialty) for Athletic Trainers (ATs) is the only board-certified orthopedic specialty for ATs with advanced knowledge, skills and experience in orthopedics. The Board-Certified Specialty in Orthopedics (BCS-O) credential is backed by the Board of Certification’s rigorous process and standards. The orthopedic specialty is much more than a certificate earned after a day-long seminar. Armed with the BCS-O, ATs are better positioned to work within the orthopedic field where they are highly valued by employers for increasing throughput, serving as an extension of the physician, connecting systems to create efficiency, and building patient relationships.
This AT specialty certification is a major step on a pathway toward improved working conditions, compensation, advancement and respect in the health care community. For ATs, this means a viable, long-term career filled with opportunities to distinguish themselves in the delivery of patient care and earning recognition and respect for the experience, focus and skills they demonstrate.
Why Earn Specialty Certification?
While it may be premature to predict all the benefits the BOC Board Certified Specialist in Orthopedics (BCS-O) credential can offer Athletic Trainers (ATs), we are starting to see that it is being accepted in place of other required credentials for certain positions and roles, such as assisting in the operating room or scrub privileges. We have also seen ATs with the credential being promoted within their field. Learn more about how the BOC Orthopedic Specialty compares to other credentials available to ATs.
Download the Comparative Matrix: BOC Orthopedic Specialty
Join Us in Educating Employers About the Value of ATs.
The BOC is working on a comprehensive initiative to educate employers about the value of Athletic Trainers, and in this case – the specialized value inherent in the orthopedic specialty. Please encourage employer contacts within your organization to share their information so that we can connect with them about the value of the orthopedic specialty. It’s a crucial part of our targeted effort on your behalf.
“In a physician practice – Athletic Trainers tend to generate more money for the organization-they possess a better skillset.”
Apply for the Orthopedic Specialty Exam
Determine Eligibility
A credential available to Athletic Trainers who have acquired specialized education and focused experience in orthopedics beyond the requirements for the ATC® credential.
The minimum requirements for the BOC Orthopedic Specialty Certification are:
- BOC Certified Athletic Trainer in good standing
- Demonstration of education and practice experience in one of the two paths below
Achieve a passing score on the Orthopedic Specialty Certification Exam
PATH 1 REQUIREMENTS
Completion of a CAATE accredited residency in orthopedics from 2012 forward and two years of practice experience after BOC certification has been earned.
- 1 YR RESIDENCY + 1 YR FULL-TIME EMPLOYMENT (before or after residency) = 2 YRS PRACTICE EXPERIENCE
CAATE accredited residencies in orthopedics:
- Atlantic Health Systems (NJ)
- Boston University (MA) Orthopedics & Diagnostics track
- Emory Sports Medicine (GA)
- Orthopedic Surgery and SPMD Teaching and Research Foundation (IL)
- Prisma Health Orthopedics (SC) (formally known as University of South Carolina)
- St Luke’s University Health Network (PA)
- St Luke’s (ID)
- The Steadman Clinic (CO)
- University of Iowa Hospitals and Clinics (IA)
- University of Michigan MedSport (MI) (CLOSED 10/11/2023)
- University of Wisconsin Hospital and Clinics (WI)
OR
PATH 2 REQUIREMENTS
Completion of at least 260 hours of professional development (e.g., continuing education, grand rounds, journal reviews, etc.) in orthopedics and four years of practice experience after BOC certification has been earned.
- Practice experience is to include at least 3500 hours in orthopedic patient care
- 1200 of the 3500 hours must be in a mentored relationship
- 1000 of the 3500 hours must be completed in the year preceding exam application.
Download BOC Orthopedic Specialty Applicant Handbook
Prepare a Study Plan
What you need to know
The BOC Orthopedic Specialty Exam was developed with the highest standards, validity and reliability. The exam prep tools and resources found in this section are divided into multiple sub components for your convenience. Please review each of them for a comprehensive overview on preparing a study plan.
Review Exam Deadlines
Complete all exam steps through your BOC profile. Applications and registrations must be received by 5 p.m. CT on the appropriate deadline date.
September 2024
Apply: Now*-8/15/2024
Register: 8/16-9/3
Schedule: 9/11^-9/26
Exam: 9/20-9/29
Results: 10/28-11/11
February 2025
Apply: Now*-1/16/2025
Register: 1/17 -1/27
Schedule: 2/5^-2/20
Exam: 2/14-2/23
Results: 3/24-4/7
September 2025
Apply: Now*-8/14/2025
Register: 8/15-8/25
Schedule: 9/3^-9/18
Exam: 9/12-9/21
Results: 10/27-11/10
BOC reserves the right to make changes as needed
^ Approximate date of when scheduling email will be received from Meazure Learning
Apply For Exam
Apply via PATH 1
- Edit and save the Practice Experience Sample Letter
- Log into your BOC profile
- Click “Orthopedic Specialty Application”
- Request confirmation of CAATE Accredited Orthopedic Residency
- Upload your edited “Practice Experience Sample Letter”
- Pay the application fee
- Your application will be processed within 3-5 business days
Apply via PATH 2
- Edit and save both of the required letters below:
- Complete the Professional Development Activity Form
- Log into your BOC profile
- Click “Orthopedic Specialty Application”
- Upload your edited documents:
- Practice Experience Sample Letter
- Mentored Hours Sample Letter
- Professional Development Activity Form
- Pay the application fee
- Your application will be processed within 3-5 business days
Apply for the Orthopedic Specialty Exam
Register For Exam
Review the BOC Orthopedic Specialty Exam Deadlines.
Complete and pay the exam fee on “AT103: Exam Registration” in your profile no later than 5 p.m. CT on the exam registration deadline date.
- Log into your BOC profile
- In the left navigation menu under the Orthopedic Specialist section click Register for Specialty Exam
Exam Fees
First time and retake candidates
Testing in the United States or Canada – $500
Testing outside the United States or Canada – $610
($500 exam fee + $115 international surcharge)
The BOC accepts Visa, MasterCard, American Express, Discover, or personal checks/money orders. Payment must be received by 5 p.m. CT on the exam registration deadline date.
Download BOC Orthopedic Specialty Applicant Handbook
Schedule and Reschedule Exam
Schedule
After you register for the exam, you will receive an email from candidatesupport@meazurelearning.com on the first date of the scheduling window (see exam deadlines) to schedule your exam site/date/time.
The BOC utilizes Meazure Learning testing centers as well as Live Remote Proctoring.
Refer to the “BOC Orthopedic Specialty Applicant Handbook” for more specifics.
Reschedule
Contact us for Email rescheduling requests
Rescheduling fees may apply
BOC allows an unlimited number of exam retakes within one year of the date of your exam results being posted. Please check with your State Regulatory Agency/Board(s) to see if they have any requirements regarding exam attempts.
Information on all exam policies (rescheduling, cancellation, failure to schedule, appeal, etc.) and accompanying fees can be found in the BOC Orthopedic Specialty Applicant Handbook
Download BOC Orthopedic Specialty Applicant Handbook
Orthopedic Specialty FAQ
The BOC will be working with employers to ensure they understand the value these specialized practitioners bring to their practice – note the topline benefits, which include operating room assistance. For any employer, optimizing the value that an Athletic Trainer can bring to a team hinges on them understanding the skills, experience and knowledge they possess. The BOC Orthopedic Specialty Certification is an important step in that direction.
The “BOC Orthopedic Practice Analysis” (OPA) defines the domains (medical knowledge, procedural knowledge, professional practice) and task statements that will be assessed on the Orthopedic Specialty Exam. We suggest Athletic Trainers review the domains and task statements comparing them to what they encounter within their specific practice. The knowledge and skills required of each domain and task statement can be found in the full OPA.
Below are a few resources of the other health care professions who have indicated as such:
https://pubmed.ncbi.nlm.nih.gov/15496048/
https://specialization.apta.org/for-specialists/marketing/employers
http://aann.org/uploads/Meetings/2020/WhitePaper_A…
The rigor involved in launching a specialty that meets the requirements of true board certification is significant. A thorough and in-depth process was followed, supported by multiple research projects, including one to define the Orthopedic Practice Analysis (OPA). The purpose of the OPA is to identify and validate the significant responsibilities that ATs who specialize in orthopedics have in their work, as well as the specialized knowledge and skills they must possess. The practice analysis study consisted of two major phases: 1) Initial Development and Validation and 2) Validation Study, both of which are outlined in detail as part of the OPA. The OPA for the orthopedic specialty is available on the BOC website.
Eligibility Questions
Exam questions are developed to assess knowledge on subject matter from the domains of orthopedic specialty in athletic training. Each question is also subjected to editing for grammar and technical adequacy by experts from the BOC’s testing agency. Thus, content experts write the questions and validate their appropriateness for the exam, and experts in testing review the questions to ensure that the questions perform as intended.
Exam Application
Path 1: Practice Experience
Path 2: Practice Experience
Path 2: Mentored Hours
We suggest reviewing your past CEU reporting forms to determine which of the CEU courses fall within the OPA. Once that is determined, a Professional Development Documentation form will serve as submission of the 260 hours of professional development activity. BOC staff will review all letters and Professional Development Forms submitted. ATs will be asked to provide additional documentation for professional development activities that do not clearly identify as falling within the domains and task statements of the “BOC Orthopedic Practice Analysis” (OPA).
BCS-O Eligibility Rationale
The following outlines the rationale used for establishing the education and experience eligibility requirements for both BCS-O eligibility pathways.
Orthopedic Residency (Path 1)
Education Rationale:
- The Commission on Accreditation of Athletic Training (CAATE) standards for residencies were published July 1, 2012.
- CAATE Standards require programs to meet standards in a focused area of clinical practice, but do not currently outline curricular content for orthopedics.
- The Orthopedic Practice Analysis is the only document that outlines specialty knowledge and skills required for orthopedics.
Experience Rationale:
- Based on related information, the experience allows the AT to gain professional maturation as an AT.
- Eligibility surveys conducted by the council and completed by those who work as an orthopedic specialist or those who employ ATs in orthopedics indicated that it takes an average of 32 months to become a specialist.
- CAATE Standard 67: Residency programs must be a minimum of twelve consecutive months with a continuous full-time practice commitment.
- Practice Analysis is currently completed approximately every 5-6 years.
- Other professions have a minimum and maximum requirement.
Alternative Route (Path 2):
Education Rationale:
- CAATE residency standards require a minimum of five hours per week of education opportunities.
- CAATE residency standards require a minimum of twelve consecutive months of full-time practice.
- The 5-6 years is consistent with the CAATE Residency Route requirement.
Experience Rationale:
- Residency is hyper focused in specialty area and more value in mentorship so alternate route requirements should be double what residency route requires.
- Eligibility surveys conducted by the council and completed by those who work as an orthopedic specialist or those who employ ATs in orthopedics indicated that it takes an average of 32 months to become a specialist.
- CAATE Standard 96: The majority of the clinical experience must be completed within the focused area of clinical practice, at least 20% of the time must occur with the preceptors in a one-on-one basis within the focused area. Path 2 requires 1200 hours to be in a mentored relationship and based on the required 3500 hours, 20% is 700 hours, which aligns with the CAATE Standard of having at least 20% of one-on-one time with a preceptor.
- Experience should be based on current practice to show person in a specialist. The 1000 hours over a year is full time and consistent with other healthcare professions.
- Practice Analysis is currently completed approximately every 5-6 years.
- Other professions have a minimum and maximum requirement.
BOC Orthopedic Practice Analysis (OPA)
To assist in your preparation, below is the free “Content Outline for the BOC Orthopedic Practice Analysis” which presents the domains and task statements you can expect to be covered on the exam. There is a fee for the complete “BOC Orthopedic Practice Analysis.”
Download Content Outline for BOC Orthopedic Practice Analysis
Purchase Full Version for $24.95 (non-refundable)
Purchase Full Version OPA
Needs Assessment
The Orthopedic Specialty Needs Assessment (OSNA) is a tool intended to assist Athletic Trainers (AT) considering the BOC Orthopedic Specialty Certification (orthopedic specialty). This tool will assess their level of preparedness for the orthopedic specialty certification exam by engaging in a self-reflection exercise of current knowledge and skills found in the Orthopedic Practice Analysis (OPA). The OSNA results will identify areas of the OPA that may require additional specialized professional development.
ATs can use the results of the OSNA to:
- Align current skills and abilities to the content defined as necessary to acquire the orthopedic specialty
- Form the framework for a professional development plan
- Assess learning needs prior to challenging the Orthopedic Specialty Certification Exam
OSNA results are for personal use only and in no way impact current or future certification status.
Launch OSNA
Self-Assessment Exam
The online orthopedic specialty self-assessment exam is available to ATs preparing for the BOC Orthopedic Specialty Certification Exam.
- The BOC offers the orthopedic specialty self-assessment exam in Study and Test modes. Study mode provides the correct answer and a reference by clicking on the “View Solution” link located on the bottom left-hand side of the screen for each question. No final score is provided or report is available in Study Mode, as the answer and reference is provided within each individual question. Test mode provides a score and brief descriptive report at the domain level immediately after completing the self-assessment exam.
- The self-assessment exam includes 50 questions that are representative of the question types on the BOC Orthopedic Specialty Certification Exam, including multiple-choice, multi-select, drag-and-drop, hot spot and focused testlets.
- Although the content areas of the orthopedic specialty self-assessment exam are comparable to those of the actual BOC Orthopedic Specialty Certification Exam, the questions included in the self-assessment exam will never appear on a future exam.
- The self-assessment exam is available online 24 hours a day, seven days a week. After purchasing a self-assessment exam, you will have 365 days to start the orthopedic specialty self-assessment exam. Once an orthopedic specialty self-assessment exam has been started, you will have seven days to complete the orthopedic specialty self-assessment exam and 12 cumulative hours to view and answer questions within the orthopedic specialty self-assessment exam. When you are ready to take an orthopedic specialty self-assessment exam, simply create a BOC profile (or log into your existing account) and click Take Self-Assessment Exam under the Orthopedic Specialist section. You will be prompted to fill out your self-assessment exam profile, and then you may purchase an orthopedic specialty self-assessment exam.
- Your performance on this orthopedic specialty self-assessment exam does not predict your performance on the BOC Orthopedic Specialty Certification Exam.
- Completion of the self-assessment exam is voluntary and is not required to take the BOC Orthopedic Specialty Certification Exam.
- The orthopedic specialty self-assessment exam items are copyrighted property of the BOC and may not be copied, reproduced, discussed or distributed in any manner. Unauthorized copying or distribution of any portion of these exams may be subject to civil liability for copyright infringement and disciplinary action pursuant to Code 3.9 of the BOC Standards of Professional Practice .
If you have additional questions or experience technical difficulties with the orthopedic specialty self-assessment exam, please contact Specialty@bocatc.org or (402) 559-0091.
Log into your BOC Profile
Exam References
The Orthopedic Specialty Exam References represents the materials used to support exam items for the BOC Orthopedic Specialty Certification Exam, as determined by the BOC Orthopedic Specialty Exam Development Committee.
Download Orthopedic Specialty Exam References
Sample Exam Questions
The BOC has prepared a set of sample items representative of each exam question type to familiarize applicants with the look and feel of the computer interface and its navigation tools. These sample questions are not representative of exam content, only format. You will not receive scores for the sample questions. If you have any questions, please contact the BOC.
Before You Begin
The BOC recommends using the latest version of Chrome or Firefox. If you are currently running Internet Explorer 10 on Windows 8, then you must first switch to Desktop Mode before accessing any self-assessment exams.
Please note: You may need to load additional plug-ins (Java, Flash) and allow pop-ups.
The sample questions are simply a tool to familiarize you with how these questions will work and appear on the specialty certification exam. This is not a study guide.
The sample questions are 25 multiple-choice, multi-select, drag-and-drop and hot spot as well as 1 focused testlet comprised of 5 questions that reference a common scenario. Make sure to utilize the help button located on the left menu.
View Sample Exam Questions
Exam Development & Scoring
Development
Questions for the orthopedic specialty certification exam are prepared by a committee made up of BOC Certified Athletic Trainers (ATs) and Orthopedic Specialty Certified ATs. Each question is validated by a panel of independent judges in item writing groups, referenced to current resources from the literature on or related to orthopedics and repeatedly edited by ATs for clarity and content. Questions satisfy the exam specifications of the current BOC Orthopedic Practice Analysis.
Questions are developed to assess your knowledge on subject matter from the three domains of orthopedics. Each question is also subjected to editing for grammar and technical adequacy by experts from the BOC’s testing agency. Thus, content experts write the questions and validate their appropriateness for the exam, and experts in testing review the questions to ensure that the questions perform as intended.
Purpose
The purpose of the Orthopedic Specialty exam is to assess your knowledge in the three domains of orthopedics as defined by the current BOC Orthopedic Practice Analysis:
- Domain 1: Medical Knowledge
- Domain 2: Procedural Knowledge
- Domain 3: Professional Practice
The questions are written, validated and reviewed by a panel of content experts in coordination with psychometricians. The Orthopedic Specialty Exam References represent the materials used to support exam items for the BOC Orthopedic Specialty Certification Exam, as determined by the BOC Orthopedic Specialty Exam Development Committee.
Format
The exam is only delivered in English and contains a combination of 125 scored and unscored (experimental) items, and applicants will not know which items are experimental. Applicants have a total of three hours to complete the exam, which includes the ability to move forward or back throughout the entire exam. The exam is an internet-based exam administered in secure and proctored professional testing centers or via LRP. The BOC exam consists of the following item types:
Stand-Alone Items
- multiple choice
- multi-select
- drag-and-drop
- hot spot
Focused Testlets
- A focused testlet consists of a scenario followed by key/critical items related to that scenario
- Each focused testlet may include multiple choice items and/or any of the previous types.
Scoring
Exams are scored by Meazure Learning, a professional testing service that specializes in certification and licensure exams.Each form of the exam includes unscored (experimental) items. Applicants are scored only on those items that have been validated and aligned to the specifications of the current “BOC Orthopedic Practice Analysis” (OPA). Candidate raw scores are then computed as the number of scored items answered correctly, with all questions equally weighted. Results are calculated on a scale from 1,000 to 1,450 with a passing point of 1,200.
Notification of Results
Exam results are posted on the applicant’s online profile within four to six weeks from the last day of the exam window. Once exam results have been posted, applicants can expect to receive an email with instructions for accessing their remote exam results. When preparing for the exam, it is important to have a thorough knowledge of the current “BOC Orthopedic Practice Analysis” (OPA). This blueprint provides the percentage of exam items from each domain represented on the exam.
Appeal of Exam Results
An applicant may appeal their exam results. If an applicant experienced exam administration issues, they should refer to section Appeal of Exam Administration. An appeal of exam results must be submitted in writing to the BOC and must specifically state the reason(s) for the appeal and why the appeal should be granted. Failing the exam alone is not sufficient grounds for an appeal.
Appeal letters should be sent by traceable mail with signature of receipt required to:
Board of Certification
Attn: Specialty
1411 Harney St Ste 100
Omaha NE 68102-2250
The appeal letter must be received by the BOC within 14 days of receipt of the remote exam results. Correspondence received after this date will not be accepted.
Within 30 days of receipt of the appeal letter, the BOC will provide a written response to the applicant regarding the outcome of the appeal.
Exams will not be re-scored. However, if an applicant appeals their exam result, Meazure Learning will conduct a comparative review to confirm that the score is correct and that all of the applicant’s answers were received.
A comparative review verifies the applicant’s answers were scored against the correct exam answer key in order to confirm that the applicant’s exam result was scored properly and correctly, and that the proper final exam score was reported. Note that the internet-based exam scoring process is very accurate and that Meazure Learning scoring process already includes several quality assurance steps, including a review of all exam results following exam administration. Results of a comparative review will be emailed to the applicant within 10 business days.
Complaints, challenges or appeals not submitted in accordance with these policies will not be acknowledged.
Exam FAQs
- Stand-Alone Items
- multiple choice
- multi-select
- drag-and-drop
- hot spot
- Focused Testlets
- A focused testlet consists of a scenario followed by key/critical items related to that scenario
- Each focused testlet may include multiple choice items and/or any of the previous types.
The exam contains a combination of 125 scored and unscored (experimental) items. There will not be a practical component. Sample Exam Questions can be found here.
Affadavit
The affidavit portion of the exam application requires applicants to report any felony or misdemeanor convictions or pending charges.
The Professional Practice and Discipline Committee reviews all convictions. Applicants are notified in writing of the committee’s decision. Please review the “Professional Practice and Disciplinary Guidelines and Procedures” for details.
The affidavit portion of the exam application requires applicants to answer the following questions when submitting their exam applications. If the answers are yes, additional documentation will be required to upload. Documentation is reviewed within two-three business days of receipt.
Question 1
Have you ever been convicted of a felony or misdemeanor and/or are felony or misdemeanor charges pending against you? For the purposes of this question, include convictions that have since been removed from your record, such as through expungement or through a pre-trial diversion program or similar process.
Required Documentation
1a. If yes, provide a detailed explanation, in your own words, of the events that led to the conviction(s).
1b. If yes, court document(s), including, but not limited to, an arrest report, sentence recommendation, proof of compliance of all court requirements and proof of payment for all related fines must be included with your application documentation.
1c. If yes and the conviction(s) were alcohol (driving related) or drug related, a current professional alcohol/substance abuse evaluation that is no older than three months must be included with your application documentation. If an alcohol/substance abuse evaluation was not required by the court, obtain an evaluation performed by a state licensed mental health professional who can provide substance abuse treatment. An online evaluation is not acceptable.
Question 2
Have you been found by any court, administrative or disciplinary proceeding to have committed negligence, malpractice, recklessness or willful or intentional misconduct, or are you currently under investigation for such?
Required Documentation
2a. If yes, provide a detailed explanation, in your own words, of the events that led to the disciplinary action for negligence, malpractice, recklessness or willful or intentional misconduct.
BOC Orthopedic Specialty Applicant Handbook
ADA Policy
The BOC, in adherence with the Americans with Disabilities Act (ADA, 1990, updated 2010), reasonable and appropriate accommodations are provided for qualified individuals with a disability who supply appropriate documentation. The BOC follows the guidelines set forth in the Council on Licensure, Enforcement and Regulation (CLEAR) and Institute for Credentialing Excellence (ICE). The BOC does not discriminate against any individual on the basis of religion, gender, ethnic background or physical disability.
Reasonable Accommodations
Reasonable accommodations provide disabled applicants with a fair and equal opportunity to demonstrate their knowledge and skill in the essential functions being measured by the exam. Reasonable accommodations are decided on the basis of the individual’s specific request, disability, documentation submitted and the appropriateness of the request.
Reasonable accommodations do not include steps that fundamentally alter the purpose or nature of the exam. The most frequent requests involve providing the candidate with extended time, a reader, a writer and/or a separate room.
Qualified Individual with a Disability
A “qualified individual with a disability” is one who has a disability and satisfies the requisite skill, experience, education and other requirements of the service, program or activity of which the individual is being measured and, with or without accommodations, can perform the essential functions of the service, program or activity.
An essential function is one that individuals are required to perform, and removing that function would fundamentally change the service, program or activity. A person must be a “qualified individual with a disability” to be protected under the ADA.
Proper Documentation
Applicants requesting a change in exam procedures or processes due to disability, handicap or other reason must request accommodations during the application process. The applicant is responsible for demonstrating that the request should be granted. The BOC will accept either of the following types of documentation:
-
- Medical Documentation
Documentation must be from an appropriate licensed professional or certified specialist who diagnosed the disability and include recommendations for reasonable accommodations. Recommendations should be based on testing that is not older than four years prior to the application. Documentation must be on the professional’s letterhead. Documentation must provide a diagnosis of the disability and the exam used to determine the disability.OR - Proof of Receiving Accommodations at College/University Level
Documentation must be provided on the college/university’s letterhead and may include an individualized education plan (IEP). IEP documentation may not be older than four years prior to the application.
- Medical Documentation
The confidentiality of all documentation submitted by the candidate is protected. The BOC will review the request and notify the applicant via email of its determination within two to three business days of receipt.
Requests for Reasonable Accommodations
- In order to be given consideration, appropriate documentation must be received by the BOC no later than 5 p.m. CT, offset UTC-six hours on the exam application deadline date of the requested exam window.
- Applicants approved for reasonable accommodations are notified via email of the accommodation(s) granted to them. Applicants not approved for reasonable accommodations are notified via email of the denial of their request.
- If an applicant’s request for accommodations is not approved, the applicant may initiate an appeal. Appeals must be made in writing to the BOC. The applicant is responsible for demonstrating that the appeal should be granted. Appeals must be received no later than 5 p.m. CT, offset UTC-6 hours on the exam application deadline date for the exam window the applicant is requesting. Failure to appeal within the allotted time will render the original decision final.
- The BOC will not pay any costs that an applicant may incur in obtaining the required diagnosis and recommendation. However, the BOC will pay for any reasonable exam-related accommodations that are provided to the applicant.