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The document is a Disability Certification Form for Western New England University, intended for clinicians to certify a student's disability diagnosis. It outlines the process for documenting disabilities to determine eligibility for services and accommodations, emphasizing confidentiality and the need for timely submission of the completed form. The form requires detailed information about the student's diagnosis, functional limitations, treatment plans, and recommendations for reasonable accommodations.

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Click ‘Get Form’ to open the Disability Certification Form in the editor.
Begin by entering the student's name in the designated field at the top of the form.
Provide a specific diagnosis in the next field, ensuring it is clear and concise.
Fill in the date of diagnosis and time of onset, as well as how long you have been working with the student.
In the 'Nature of Disability' section, describe any functional limitations imposed by the condition. Be detailed about how it affects major life activities and participation in university programs.
Outline any current treatment or follow-up plans that are relevant to the student's condition.
Finally, provide specific recommendations for reasonable accommodations based on your assessment of the disability.
Complete your information at the bottom, including your name, credentials, and signature before submitting.

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