Verification of Disability Form

Verification of Disability Form

The student named below is requesting accommodations due to the impact of a disability. To evaluate that request, our office is requesting that the following form be completed by a qualified professional who has first-hand knowledge of the student's condition and is an impartial individual not related to the student. The provision of reasonable accommodations is based on assessment reports and the current impact of the disability on academic performance. It should be noted that academic accommodations are intended to ensure access to educational opportunities for students with disabilities, not to make adjustments that would fundamentally alter the nature of the course, course components, or course requirements.
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  • Certifying Professional:

  • Diagnosis

    Please attach any assessment reports and/or scores from any diagnostic tests that were used to support this diagnosis.
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  • Impact of Condition on Educational Access

  • Max. file size: 43 MB.
  • Max. file size: 43 MB.
  • Max. file size: 43 MB.
  • Max. file size: 43 MB.