Documents & Forms
Documentation for students with disabilities
In order to fully evaluate requests for accommodations or auxiliary aids and to determine eligibility for services, the Center for Student Success must have recent documentation (within three years) of the disability. The documentation should include an evaluation by an appropriate professional that makes evident the current impact of the disability as it relates to the accommodation(s) requested.
The general guidelines listed below are developed to assist the student in working with treating/diagnosing professional(s) to prepare the information needed to evaluate the student's request(s). If, after reading these guidelines, there are any questions, feel free to call the office at 330-471-8496.
- Current functional impact of the condition(s)
The current relevant functional impacts on physical (mobility, dexterity, endurance, etc.), perceptual, cognitive (attention, easily distracted, communication, etc), and behavioral abilities should be described as a clinical narrative and/or through the provision of specific results from the diagnostic procedures and assessments. - Treatments, medications, accommodations/auxiliary aids, services currently prescribed or in use
Provide a description of treatments, medications, accommodations/auxiliary aids and/or services currently in use and their estimated effectiveness in minimizing the impact of the condition(s). Include any significant side effects that may impact physical, perceptual, behavioral or cognitive performance. If the student feels any additional accommodations/auxiliary aids are warranted, please list them along with a clear rationale and related functional limitations. Any accommodations or auxiliary aids will be taken into consideration, but not automatically implemented. - The expected progression or stability of disability over time
If possible, provide a description of the expected change in the functional impact of the condition(s) over time. If the condition is variable, describe the known triggers that may exacerbate the condition. - A diagnostic statement identifying the disability
When appropriate, include International Classification of Diseases (ICD) or Diagnostic Statistical Manual (DSM) codes, the date of the most recent evaluation, or the dates of evaluations performed by referring professionals. If the most recent evaluation was not a full evaluation, indicate when the last full evaluation was conducted.
Most common disabilities
In order to receive academic accommodations, the student must provide documentation of the disability from an appropriate professional.
Attention Deficit Disorder
- A copy of a diagnostic report from within the last three years which states the DSM diagnosis, symptoms, and functional limitations
- Instruments and procedures used to make the diagnosis
- Dosage, type, and frequency of medication.
Download this form to be filled out by a professional.
Deaf or Hard of Hearing
- A copy of the most recent audiological examination, including diagnosis with etiology, degree, type, functional limitations, and configuration of loss.
Download this form to be filled out by a professional.
Learning Disability
- A copy of a comprehensive psycho-educational test battery administered within the last three years, with a statement of diagnosis, academic limitations resulting from disability, and type of learning disability (all test scores must include subtest scores);
- A copy of a recent IEP and Multi factored Evaluation, if available.
Download this form to be filled out by a professional
Medical Disability
- Statement of diagnosis, functional limitations, impact of the disability in an academic setting, and medication, including side effects.
Download this form to be filled out by a professional
Mobility Impairment
- Diagnosis of mobility impairment and a statement of functional limitations, medications, dosages, and side effects.
Download this form to be filled out by a professional
Psychologist/Psychiatric Disability
- A DSM diagnosis from a psychologist or psychiatrist stating diagnosis, characteristics of the disability, functional limitations, projected duration, and medication.
Download this form to be filled out by a professional
Visual Impairment
- A copy of the most recent eye examination, including diagnosis, visual acuity, and functional limitations.
Download this form to be filled out by a professional
Students with other types of disabilities should consult with Anna Meadows at 330-471-8496 or ameadows@malone.edu to determine the required documentation.