Please provide these guidelines to your diagnosing/treating professional provider. Your provider will need to ensure that the documentation submitted in support of your request for disability accommodation includes all pertinent information as set forth in these guidelines.

Note that documentation must be completed by a provider qualified and licensed to diagnose and assess your particular disability(ies), and must be current.

Students with physical disabilities, including hearing and vision impairments, requesting disability accommodations through the Learning Resource Center must furnish documentation that includes:

1. Diagnostic Statement – A statement identifying the nature and extent of the impairment(s), the assessment or evaluation procedures/tests used to make the diagnosis, and the date of the current diagnostic evaluation. Physical diagnoses must include information about symptoms and how these relate to criteria set forth in the International Classification of Diseases manual (most recent edition).

2. Current Functional Impact – A detailed description of the current functional impact of the impairment(s) in the unmitigated state (without any treatment, medication, etc.), as relevant to the request for accommodations. The documentation should describe how the impairment(s) limit(s) one or more major life activities: How do specific symptoms of the impairment interfere with or prevent specific activities?

3. Expected Progression or Stability – A description of the expected progression or stability of the impact of the impairment(s) over time, along with a recommendation concerning the need for reevaluation.

4. Specific Recommended Accommodations - A detailed explanation of the recommended accommodations and why each recommended accommodation is necessary due to current functional limitations. Current treatments, medications, assistive devices or self-accommodations may be referenced, with an explanation of effectiveness, any significant side effects that may impact functional abilities, and how these bear on the specific accommodations requested.

5. Credentials – Documentation must be on official letterhead from the offices of the professional provider, dated and signed. Professional providers must have comprehensive relevant training and direct experience in the diagnosis and treatment of the impairment. The provider must hold a current license in the state in which they practice.

MICA reserves the right to request additional documentation as necessary to fully evaluate individual requests for disability accommodations.