Students seeking accommodations at the University of Southern Maine must document a disability as defined by the Rehabilitation Act, Section 504 and the Americans with Disabilities Act. This documentation must be provided to the Disability Services Center (DSC) prior to receiving services. Students qualified under these laws are protected from discrimination in all University programs, activities, services and facilities.
Under these laws, an individual with a disability means any person who:
1. has a physical or mental impairment which substantially limits one or more major life activities, including caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, sitting, standing, lifting and working, as well as mental and emotional processes such as thinking, concentrating and interacting with others;
2. has a record of such an impairment; or,
3. is regarded as having such an impairment.
Students with disabilities must provide evidence of both a disorder and related current, significant, functional limitations to become eligible for accommodations. Designed to provide equal access, accommodations are provided only in response to the functional limitations of a disability as they clearly intersect with academic demands. Accommodations do not include interventions, which are remedial, needed for personal study and care, or designed to ensure desired outcomes.
Please provide the following information under separate cover and on practice letterhead and mail or fax to the above address or fax. The authorized release of information is to include but not be limited to the following:
NOTE: Copies of Medical Records Will Not be Accepted
1. Presenting diagnosis (es) utilizing diagnostic categorization or classification of the ICD or DSM IV. Diagnoses should indicate primary, secondary, etc., and significant findings, particularly in respect to presenting problems.
2. Date the examination/assessment/ evaluation was performed for the presenting diagnosis, or if following the student for an extended time, date of onset and date of an evaluation of the condition that is recent enough to demonstrate the student’s current level of functioning.
3. If a temporary condition, what is the expected length of time to recover?
4. Tests, methodology used to determine disability.
5. Identify the current functional limitations, if any, on the student’s physical, perceptual and cognitive performance in activities such as, mobility, self-care, note taking, laboratory assignment, testing/examinations, housing conditions/arrangements.
6. Describe any treatments, medications, assistive devices or services the student currently is using. Note their effectiveness and any side effects that may impact the student’s physical, perceptual or cognitive performance.
7. Recommendations for accommodations; explain the relationship between the student’s functional limitations and the recommendations.
8. List the credentials (certification, licensure and/or training) of the diagnosing professional (s).
Thank you for taking the time to provide the information requested. If you have questions regarding this form please call OSSD at the above number.
Return this information marked confidential to:
Disability Services Center
University of Southern Maine
P.O. Box 9300
Portland, Maine 04104-9300
Note: This information is kept confidential except as required by law.