Certification Forms for Psychiatric Disability

Under the Americans with Disabilities Act (ADA) of 1990 and Section 504 of the Rehabilitation Act of 1973, individuals with disabilities are protected from discrimination and may be entitled to reasonable accommodations. To establish that an individual is covered under the law, documentation must indicate that a specific disability exists and that the identified disability substantially limits one or more major life activities. A diagnosis of a disorder in and of itself does not automatically qualify an individual for accommodations and academic adjustments. In order to determine eligibility and to provide services, we require documentation of the student’s psychological disability.

After completing this form, please print it out, sign it, and mail or FAX it to us at the address listed on this page. The information you provide will not become part of the student’s educational records, but will be kept in the student’s file at the Office of Learning Support Services, where it will be held strictly confidential. This form may be released to the student at their request. In addition to the requested information, please attach any other information you think would be relevant to the student’s academic adjustment. Please contact us if you have questions or concerns. Thank you for your assistance.

Certification Forms for Psychiatric Disability