Disability Documentation Form

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Washington and Lee University provides accommodations for students with disabilities. The documentation provided must demonstrate a disability and need for accommodations.

The form below has been developed to assist the treating or diagnosing healthcare professional (psychiatrist, psychologist, counselor, therapist, medical doctor, optometrist, audiologist, etc) to provide the specific information needed to evaluate the student’s eligibility for accommodations.

The healthcare professional(s) conducting the assessment and/or making the diagnosis must be qualified to do so. The type of professional specialist involved will differ depending on the nature of the diagnosis. However, all professionals must have comprehensive relevant training and must hold a current license in the state in which they practice.

Relevant definitions:

  • 'Disability' is a physical or mental impairment that substantially limits one or more major life activities. A diagnosis of an impairment, though required, does not in and of itself automatically mean that the individual qualifies for a reasonable accommodation. An impairment only constitutes a disability when it prevents an individual from performing a major life activity that the average person in the general population can perform or when the individual is substantially limited as to the condition, manner or duration he/she can perform a particular major life activity as compared to the average person in the general population.
  • An impairment that is episodic or in remission can constitute a disability if it substantially limits an individual in a major life activity when it recurs.
  • A 'reasonable accommodation' is a reasonable modification or adjustment to a class or program or the provision of auxiliary aids/services that allows a qualified student with a disability equal opportunity to participate in university programs and activities.

Please fill out the following form on behalf of your client and attach any relevant test results supporting the diagnosis(es). The information you provide will be kept in the student’s file at Disability Resources, where it will be held securely and confidentially. This form may be released to the student at his/her request.

If you have questions regarding this form, please call or email the Director of Disability Resources at 540-458-4055 or kozakl@wlu.edu. Thank you for your assistance.

Student Information

Diagnostic Information

Please provide a copy of any test results supporting the diagnosis(es) or other information used to reach the diagnosis(es).
For each functional impact described in the answer above, please indicate the severity of the impact (mild, moderate, severe).

Please note: documentation statement(s) from clinician parents/relatives will not be accepted.