Pervasive Developmental Disability Autism or Asperger's Syndrome by ezm24188


									            Pervasive Developmental Disability: Autism or Asperger’s Syndrome
                                   Verification Form

Students requesting accommodations must submit documentation of a disability as defined by Title II
of the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act of 1973, and
Columbus College of Art & Design policies. Providing detailed information about the functional
impact of a disability is essential for determining reasonable accommodations.

CCAD requires a specific diagnosis of Autism or Asperger’s syndrome consistent with the DSM-IV
criteria. Please provide a written report or summary on official letterhead and attach supporting data.

    • Specific description of diagnosis
Documentation should include a clear statement of diagnosis along with a written description of the
current or potential impact of the condition on the college experience including: academic, social,
and emotional functioning.

    • History
Approximate age and date of first and most recent diagnosis; prior accommodations and/or
treatments; evidence of impact on academic functioning.

   • Comprehensive neuropsychological evaluation
Summary of assessment procedures including diagnostic test results should be submitted. Please
note that less detailed evaluations, tests normed for children instead of adults, and evaluations older
than three to five years may limit the ability to establish accommodations.

     • Recent documentation
Documentation should be based on an assessment conducted within the past three to five years. It is
in a student’s best interest to provide recent documentation to guide decision-making.

    • Specific recommendations for accommodations
Provide a clear statement as to why specific adjustments are recommended to mitigate the impact
the disability in the academic setting.

    • Current medications
Dosage, type, and frequency of current medication (if applicable) and information about significant
side effects that may affect academic performance may be useful.

    • Qualifications of diagnosing professional
The following professionals are considered qualified to evaluate and diagnose pervasive
developmental disabilities: clinical psychologists, neurophysiologists, psychiatrists, and qualified
medical doctors. Name, title, address, and telephone of diagnosing professional must be provided.

Submit documentation to:
Learning Support Services                               Phone: 614-222-4004
Columbus College of Art & Design                        Fax: 614-222-4034
107 North Ninth Street
Columbus, OH 43215                                      All documentation is considered confidential

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