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The following form can be completed to support the student’s disability, physical health, mental health, and/or temporary conditions by a healthcare provider (psychologist, psychiatrist, therapist, licensed clinical social worker, medical doctor, optometrists, etc.) who is not a family member of the student and/or who does not have an inherent conflict of interest. This will be used to determine eligibility for reasonable accommodations.

A letter can be provided by a qualified treating or diagnosing healthcare provider (psychologist, psychiatrist, therapist, licensed clinical social worker, medical doctor, optometrists, etc.) who is not a family member of the student and/or who does not have an inherent conflict of interest. Documentation can be completed on the healthcare provider’s official letterhead and signed by the credentialed professional. Information should contain:

1. A diagnostic statement identifying the disability with a date of diagnosis;
2. The impact of the disability;
3. An assessment of major life activities that are affected by the impairment (concentration, social interactions, learning, thinking, walking, standing, sitting, etc.)
4. Include test scores/diagnostics when applicable; and
5. Must include name, title of the professional, license number, address, phone and signature of the professional.

A neuropsychological or psychological report ideally completed after the student’s thirteenth birthday is acceptable documentation. The report must be completed. Giving parts of the report instead of a full report is not acceptable.

An Individualized Education Plan (IEP) is acceptable for students with learning disabilities, developmental/cognitive/intellectual disabilities, or students diagnosed with Autism/Autism Spectrum. However, the last IEP (transition) is not accepted. The Disability Resource Center requests the three year re-evaluation and/or psychological report with eligibility. These documents may be requested from the high school.

Additionally, students may submit a 504 plan, educational plan from a private high school, a local educational agency, a State educational agency, or Letter of Accommodation from a previous post-secondary institution such as a community college.

While Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder is not a learning disability, students are eligible for accommodations supported by documentation from options one, two or three. 

Students who are Deaf or Hard of Hearing should provide diagnostic results from a full hearing test performed by a qualified professional. Documentation must address the following:

• Relevant medical history, including date of hearing loss;
• Specific diagnosis and recent audiogram;
• Description of functional limitation (with and without any hearing aids or other assistive devices or treatments); and
• Additional information that can be helpful would be an IEP or 504 Plan.

Students who are diagnosed with blind/low vision must provide a copy of the complete ocular examination from an optometrist or ophthalmologist that includes:

• Diagnosis and original diagnosis date;
• Etiology/cause;
• Impact or limitation (including acuity scores);
• Visual acuity with or without correction;
• Status of corrective lenses (glasses and/or contact lenses and any other devices); and
• Additional information that can be helpful would be an IEP or 504 Plan.

Students who have documentation of a disability due to military service may submit information from military professionals including letters from the Department of Veterans Affairs. 

Documentation can be submitted:

• By Email at drc@niu.edu
• Mail: Northern Illinois University, Disability Resource Center, 1425 W. Lincoln Highway, DeKalb, IL 60115
• Fax: 815-753-9570
• Drop off: Peters Campus Life Building in Suite 180