You have three options for completing this form:
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.
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 email@example.com. Thank you for your assistance.
Please note: documentation statement(s) from clinician parents/relatives will not be accepted.