• Complete and submit a Student Accommodation Request Form and upload documentation (See Documentation Guidelines).
• Documentation must be current and prepared by a medical professional or health care provider, i.e. typed on office/practice letterhead, dated, and signed by a professional who is licensed or certified in the area for which the diagnosis is made.
• If applicable, provide a previous copy of an Individualized Education Plan (IEP), Summary of Performance (SOP), or a 504 Plan.

For additional assistance contact the Office of Disability Services, One-Stop Student Service Center.

Student Accommodation Request Form

Required Documentation

Submit a current (within 5 years) neuropsychological, psychological, or ADHD testing report specifying a diagnosis of ADHD, signed and dated by the examiner; or

Submit responses to the following questions completed by a medical or psychological examiner and typed on letterhead. The letter must be signed, dated and include licensure/certification information. Do not submit handwritten documentation.

1. Diagnostic code (DSM-IV, IV-R, V), date of diagnosis, and date of last visit.
2. Severity of condition: mild, moderate, or severe. Please provide examples.
3. How did you arrive at your diagnosis? Possible responses include: structured or unstructured interviews with the student or other persons, behavioral observations, developmental/medical history, educational history, or rating scales.
4. What medication(s) does the student take for ADHD? Do symptoms persist even with medication?
5. Describe in detail the present impact of ADHD in two or more major areas of the student’s life. Accommodations will be determined based on this information.
6. List ADHD symptoms which were present before the age of 7.
7. Please list and explain other medical conditions or psychiatric diagnoses that may affect the academic performance of this student.

Required Documentation

The following professionals are considered qualified to assess and diagnose autism spectrum disorder:

• psychologists;
• psychiatrists;
• developmental pediatricians;
• neurologists; or
• an interdisciplinary team.

All reports should be on letterhead, dated, signed, and include the name, title, and professional credentials of the evaluator.

• A psychoeducational report including social-behavioral testing should be current within five years. Documentation should substantiate the need for service based on the student’s current functioning in an educational setting. If the student has been evaluated by an autism center such as TEACCH, please include the evaluation in the submitted documentation. Do not submit handwritten documents.
• A clear diagnostic statement of the disorder, including DSM-IV, IV-R, or V diagnosis, and a summary of present symptoms must accompany the documentation. In addition, a summary of evaluation procedures, diagnostic tests used, and evaluation results should be included.  A comprehensive report would include: ability testing, achievement testing, and specific cognitive processing evaluated for strengths and weaknesses, including visual-spatial processing

The Slosson Intelligence Test and the Kaufman Brief Intelligence Test are primarily screening devices which are not comprehensive enough to provide the information necessary to make accommodation decisions.

The Wide Range Achievement Test is not a comprehensive measure of achievement and, therefore, is not useful as the sole measure of achievement.

The impact of the disability on the individual should be discussed with particular detail regarding academic and social requirements. If specific recommendations of accommodations are made, the rationale must relate the accommodation to the functional limitations imposed by the disability.

Required Documentation

• An audiogram indicating the severity of the hearing impairment must be provided by a licensed audiologist.
• If specific recommendations of accommodations are made, the rationale must relate each accommodation to the functional limitations imposed by the disability.
• If other disabilities are present, please provide additional reports.

Required Documentation

The following appropriately licensed/certified clinical professionals are considered qualified to assess and diagnose learning disabilities:

• psychologists;
• school psychologists, and
• neuropsychologists.

The professional must have expertise in evaluating the impact of the learning disability on the student’s educational performance. All reports should be on letterhead, dated, signed, and include the name, title, and professional credentials of the evaluator.

• A psychoeducational report should be current within five years. Documentation should substantiate the need for service based on the student’s current functioning in an educational setting.
• A psychoeducational evaluation should include a clinical interview. The student’s developmental, academic, mental, and social history should be investigated and reported. This evaluation must include a comprehensive assessment battery including aptitude, achievement, and processing instruments.

The following aptitude tests are considered appropriate in the substantiation of a learning disability:

• Wechsler Adult Intelligence Scale-IV (WAIS-IV); Wechsler Intelligence Scale for Children-IV (WISC-IV)
• Woodcock-Johnson Test Psychoeducational Battery-III: Test of Cognitive Ability
• Kaufman Adolescent and Adult Intelligence Test (KAIT)

The Slosson Intelligence Test and the Kaufman Brief Intelligence Test are primarily screening devices which are not comprehensive enough to provide the information necessary to make accommodation decisions.

The following achievement tests are considered appropriate in the substantiation of a learning disability:

• Woodcock-Johnson Psychoeducational Battery-III: Tests of Achievement
• Wechsler Individual Achievement Test-II (WIAT-III)
• Scholastic Abilities Test for Adults (SATA)

The Wide Range Achievement Test is not a comprehensive measure of achievement and, therefore, is not useful as the sole measure of achievement.

The impact of the disability should be discussed with particular detail regarding academic requirements. If specific recommendations of accommodations are made, the rationale must relate the accommodation to the functional limitations imposed by the disability.

Required Documentation

Documentation should be prepared by a licensed/clinical physician qualified to diagnosis the disability. All documentation must be submitted on the official letterhead of the professional describing the disability. The report should be dated, signed and include the name, title, professional credentials of the evaluator, and include the following information:

• A current diagnosis with date of diagnosis, date of last visit, and severity of the condition should be included, as well as treatment history and treatment plan. The Office of Disability Services reserves the right to request additional documentation if deemed necessary to provide reasonable and appropriate accommodations.
• The impact of the condition on the individual should be discussed with particular detail regarding academic requirements. Documentation consisting only of a diagnosis, chart notes, and/or prescription pad notations is insufficient. Do not submit handwritten documentation.
• If specific recommendations of accommodations are made, the rationale must relate the accommodation to the functional limitations imposed by the disability.
• What medication(s) does the student take for emotional/mental health support? Do symptoms persist even with medication?
  In cases of head trauma or medical conditions which affect the brain, a current neuropsychological or psychological evaluation report may allow the student to be accommodated more thoroughly.

Required Documentation

Documentation should be prepared by a licensed/clinical:

• psychologist;
• psychiatrist; or
• other professional qualified to diagnosis emotional/mental health disabilities.

All documentation must be submitted on the official letterhead of the professional describing the disability. The report should be dated, signed and include the name, title, and professional credentials of the evaluator, and include:

• A current diagnostic code (DSM-IV, IV-R, V), date of diagnosis, date of last visit, and severity of the condition should be included, as well as treatment history and treatment plan. DSS reserves the right to request additional documentation if deemed necessary to provide reasonable and appropriate accommodations.
• The impact of the disorder on the individual should be discussed with particular detail regarding academic requirements. Documentation consisting only of a diagnosis, chart notes, and/or prescription pad notations is insufficient. Do not submit handwritten documentation.
• If specific recommendations of accommodations are made, the rationale must relate the accommodation to the functional limitations imposed by the disability.
• What medication(s) does the student take for emotional/mental health support? Do symptoms persist even with medication?
• A current neuropsychological or psychological evaluation report may allow the student to be accommodated more thoroughly.

Required Documentation

Documentation must be provided by an:

• ophthalmologist;
• optometrist; or
• other licensed eye care professional.

All documentation must be submitted on the official letterhead of the professional describing the disability. The report should be dated, signed and include the name, title, and professional credentials of the evaluator.

• Documentation should include a diagnosis and specify best corrected visual acuity and degrees of visual field in each eye. Include the date of diagnosis, date of last visit, and severity of the condition, as well as treatment history and treatment plan.
• Describe the impact the impairment has on the individual’s visual ability and the functional limitations it may impose. The impact should be discussed with particular detail regarding academic requirements. Documentation consisting only of a diagnosis, chart notes, and/or prescription pad notations is insufficient. Do not submit handwritten documentation.
• If specific recommendations of accommodations are made, the rationale must relate the accommodation to the functional limitations imposed by the disability.