Policies: Student Rights: ADA:

Documentation Checklists:

AD/HD Documentation Checklist
It is recommended that the information on the checklist be addressed by the professional evaluator in providing documentation for Attention Deficit/Hyperactivity Disorder.

Diagnostic code (ICD or DSM IV � R): _________________________________

Level of Severity: ____ Mild ____ Moderate ____ Severe

Date of Diagnosis: __________________________________________________

Documentation information should include (but not necessarily be limited to, the following:

• Report of history of AD/HD by age of seven years
• History of presenting attentional symptoms, including evidence of on-going impulsive/hyperactive or inattentive behavior that has significantly impaired functioning over time.
• Family history for presence of AD/HD and other educational, learning, physical and/or psychological difficulties deemed relevant by the professional evaluator.
• Relevant medical and medication history, including the absence of a medical basis for the symptoms being evaluated.
• Relevant psychological history and any relevant interventions.
• A thorough academic history of elementary, secondary, and post-secondary education (including prior accommodations and/or services that the student received, information about specific conditions under which the accommodations were used, and whether or not they benefited the student).

Head Injury/Traumatic Brain Injury Checklist
It is recommended that the information on this checklist be addressed by the professional evaluator in providing documentation of Head Injury/Traumatic Brain Injury.

• A clear description of the head injury or traumatic brain injury and the probable site of lesion.
• Documentation of eligibility should be current, preferably within the last three years or from a date following further injury or significant therapy, (the age of acceptable documentation is dependent upon the disabling condition, the current status of the student and the student's specific request for accommodations, and is most useful when it describes current functioning. See #5 below).
• A summary of cognitive and achievement measures used including standardized scores or percentiles used to arrive at the conclusions.
• Medical information relating to student's needs to include the impact of medication on the student's ability to meet the demands of the post-secondary environment.
• A statement of the functional impact of limitations of the disorder or disability on learning or other major life activity and the degree to which it impacts the individual in the academic setting for which accommodations are being requested. A neurological educational assessment battery is most helpful in designing appropriate accommodations.
• Description of any referrals suggested for further testing or evaluation (the College does not have a Health Center or conduct any medical or psychological testing).
• Description of any referral or suggestions made for other treatment or therapy, including any current on-going therapy that may affect academic or learning strategies.

Helpful: Suggestions of reasonable accommodations which might be appropriate at the post-secondary level. These recommendations should be supported by the diagnosis.

LD Documentation Checklist
It is recommended that the information on this checklist be addressed by the professional evaluator in providing documentation for Learning Disability.

Specific Diagnosis: _________________________________________________

Date of Diagnosis: __________________________________________________

• A summary of the student's history, including information about age of first identification, special services utilized and recommendations made for post-secondary education.
• A clinical summary including a summary of the diagnostic interview.
• A clear and specific diagnostic summary, using terminology consistent with the DSM-IV wherever possible. It should include a clear statement that a learning disability is present along with the rationale for this diagnosis. (Note: individual "learning deficits", learning styles", and learning differences", do not, in and of themselves, constitute a learning disability).
• Measurements of aptitude, academic achievement, and information processing, including, all scores, scales, percentiles on sub-tests. For example, a measure of fluid reasoning and sequencing is of potential value where mathematics related impairment or dyscalculia is indicated.
• A statistical analysis of specific discrepancies if any, identifying how expected performance level was calculated and how actual achievement has been contrasted with expected performance (include all test scores, sub-scores, percentiles and measures of intra-individual patterns and discrepancies between expected performance and actual achievement if any).
• Be reasonable current (assessment done in late high school or as an adult, or following an additional injury or therapy that is relevant to the impairment). Nationally, guidelines often specify a request that documentation for adults be within the last 3 to 5 years; some institutions require 3-year recency or less for specific conditions.
• A statement of strengths and needs that will impact the student's ability to meet the demands of the post-secondary environment, including a explanation of the functional impact or limitations of the disability on learning or other major life activity associated with college attendance, and the degree to which it impacts the individual in the learning context for which accommodations are being requested.
• Be technically sound, reliable, valid for the adult population and document the functional nature and severity of learning disabilities, if any.