Disability Verification Form

The Disability Services Office at Rhode Island College requires verification of a disability in order for students to receive accommodations based on a disabling condition. Verification of a disability; physical, hearing, vision, motor, learning (including attention disorders), speech, chronic disease, neurological, psychological, and other disorders - must originate from a licensed physician or professional who specializes in the diagnosis and treatment of the disability.

Please note that the confidentiality of the student is protected at all times. Specific disability related information is used only to determine proper accommodations and is not shared with faculty or staff outside the Disability Services Office.

Information regarding the student’s disability should be typed on letterhead stationary and should include the following:

1. Statement of Condition/Diagnosis
2. DSM IV Code and Severity (if applicable)
3. Tests Preformed with Scores and Percentiles (if applicable)
4. How the Condition Substantially Limits Major Life Functions
5. Current Treatment
6. Specific Recommendations for Reasonable Accommodations and an Explanation of the need for the Specific Recommendation
7. Duration (if applicable)
8. Other: _____________________________________________________

Disability Verification documentation and/or test results should be no more than three years old.

Please forward the requested information to:

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