This article presents a framework for practitioners in education and psychology to select accommodations based on student profiles and testing demands. A brief history of testing accommodations policy in the US and a definition of terms provide context for the discussion. A review of theory and empirical findings related to testing accommodations follow. The key assumption is that testing accommodations are used to obtain test scores from which valid inferences can be drawn. The article introduces a three-step process that involves identifying access skills, selecting accommodations, and considering their impact on target skills or knowledge. The reader is also introduced to tools that are commercially available to help with these decisions. (Contains 3 tables and 2 figures.)