Documentation of Disability Form

Documentation of Disability Form

Please note, this information will be considered by the Accommodations and Modifications Committee which is comprised of UNC professionals representing Faculty and Program Staff, Campus Health, Counseling and Psychological Services, Carolina Housing, Carolina Dining, The Learning Center and Accessibility Resources and Service, in addition to any other documentation presented by student.

This is not a mandatory form, but may be used by treating providers as a means of furnishing ARS with information and documentation to support the student's accommodations request(s).

Documentation must reflect that the condition substantially limits a major life activity or major bodily function. ARS utilizes flexibility and discretion in determining how recent documentation must be.  Changing conditions and/or changes in how a condition impacts the individual may warrant more frequent updates.  Generally, sufficient documentation includes: a psychological/psycho-educational evaluation or a letter from medical/mental health provider which includes the below numbered items.

1. Qualifications of Clinician/Provider:

Documentation must be typed on office or practice letterhead, dated and signed by a professional who is licensed or certified in the area for which the diagnosis is made. Name, title, and license/certification credentials must be stated and shall not be family members or others with a close personal relationship to the individual.

2. Diagnosis & History:

A diagnostic statement identifying the disability including ICD or DSM classification along with any relevant personal, psychosocial, medical, developmental and/or educational history.

3. Description of Diagnostic Methodology:

A full description of the diagnostic methodology used, including data and measurements from appropriate evaluation instruments. The results obtained should draw a direct link to the diagnosis and the functional limitations of the disability. For cognitive disorders, evaluations should use adult norms.

4. Current Impact and Functional Limitations:

A clear description of the level of severity along with the current impact and functional limitations pertaining to the academic and/or residential settings. Information regarding if symptoms are constant or episodic, and the frequency and/or duration should be addressed.

Please also include information about any treatments, medications, and/or assistive devices/services currently prescribed or in use, should include a description of the mediating effects and potential side effects from such treatments.

5. Recommendations:

Recommendations are welcomed and considered, however ARS makes the ultimate determination on eligibility and reasonable academic adjustments necessary to provide equal access for participation in academic courses, programs and activities.  Recommendations should be directly linked to the impact or functional limitations associated with the disability, or medication prescribed to control symptoms and include a clear rationale based on level of impairment.

Emotional Support Animal (ESA) documentation should include statements specific to:

  • ​the existing and continuing diagnostic and therapeutic relationship you have with your provider
  • your provider’s specific diagnosis of the condition and its severity
  • the methodology used to arrive at this diagnosis
  • ​the functional limitations resulting from this diagnosis and a clear articulation of how the animal will mitigate these functional limitations
  • the provider’s confirmation that the ESA has been prescribed for treatment purposes and as part of a care plan and is necessary to help alleviate symptoms associated your condition and/or how it will be critical in allowing you to use and enjoy university housing services. 

Generally, documentation from a mental health care professional who creates and reviews an emotional profile and produces a template ESA letters for public housing and air carriers and who have no contact with the student except for limited encounters specifically intended to produce a letter to act as ESA documentation is not considered reliable; the professional/client relationship will often lack diagnostic rigor and does not provide the level of familiarity with  the functional limitations arising from the diagnosis necessary to support robust recommendations. Also, please be aware that the ARS office neither requires nor recognizes an ESA "license", "certificate" or "vest" as the basis for establishing the legitimacy of an ESA.

About you, the professional completing this form
The student
Your professional contact with the student
Diagnosis 1
Diagnosis 2
Diagnosis 3