COLLEGE ACCOMMODATION LETTER
Disability documentation for academic accommodations

[Practice name]
[Address]
[Phone and email]

Date: [Date you write the letter]

To: [Disability or accessibility services office], [College or university]
Student: [Student's full name]
Date of birth: [Date]
Student number: [If the student gave it]
Office's own form: [Completed and attached, or none provided]

This letter supports [student name]'s registration with your office. The student requested it and consented to each part.

RELATIONSHIP TO THE STUDENT
Role: [Family physician, psychiatrist, psychologist, nurse practitioner, or other role]
Seen since: [Month and year]
Most recent assessment: [Date], [in person or by video]

THE CONDITION
[The diagnosis, or a plain description of its general nature if the student chooses that and the office accepts it]
Diagnosed: [Month and year]
Nature: [Permanent, long term with flare-ups, or temporary]
Expected course: [Stable, improving, variable, or expected to resolve by a date]

FUNCTIONAL LIMITATIONS IN STUDY, AS OF NOW
Reading and writing: [Effect, or none]
Concentration and stamina: [How long the student can work before a break, or none]
Attendance and mobility: [Classes likely to be missed, getting around campus, or none]
Tests and exams: [What happens under exam conditions, or none]
During flare-ups: [How often, for how long, and what changes, or not applicable]

TREATMENT AND STUDY
[Side effects that matter for study, such as drowsiness or slowed thinking, and treatment or appointment times that clash with classes, or none]

ACCOMMODATIONS THAT FOLLOW FROM THESE LIMITS
1. [Accommodation]: for [the limitation it addresses]
2. [Accommodation]: for [the limitation it addresses]
3. [Accommodation]: for [the limitation it addresses]

I understand that your office decides which accommodations to put in place. I will review the student's needs by [review date], or sooner if they change.

[Your name, credentials]
[License or registration number]
[Signature]
[Practice phone, for questions the student has agreed I can answer]