Get Student Disability Verification Multiple Campuses Pdf - Ccsf

This guide provides step-by-step instructions for accurately completing the Student Disability Verification form required by the City College of San Francisco. Following these clear instructions will help ensure you provide the necessary information to receive disability-related services.

Follow the steps to complete the form online seamlessly.

1. Use the ‘Get Form’ button to acquire the document and open it in your preferred editor.
2. Begin by entering your personal information in the section labeled 'This section must be completed by the student.' Fill in your last name, first name, middle name, medical record number or CCSF ID, birthdate, address, phone number, city, state, zip code, and email address.
3. In the next section, request that your licensed or certified professional complete the form by providing their name, address, phone number, city, state, zip code, and fax number.
4. The licensed or certified professional will need to provide details about the diagnosis, including any applicable DSM IV code and severity. They will also need to indicate functional limitations related to the disability by checking relevant boxes and providing additional information if needed.
5. Next, the professional must state the duration of the disability, specifying whether it is permanent, chronic, or temporary, and provide any estimated duration for temporary disabilities along with the expected re-evaluation date.
6. They will also indicate the stability of the condition, checking either 'Stable' or 'Prone to exacerbations.'
7. At the bottom of this section, the professional will need to print their name, sign the form, provide their title, and date the completion of the form.
8. If someone other than the diagnosing professional completed this form, include their name and address to clarify the source of the diagnosis.
9. Make sure to attach any required educational, medical, or psychological documentation as requested on the other side of the form before returning it to the appropriate DSPS office.
10. Finally, ensure that you save your changes, download, or print the completed form for submission.

Complete the Student Disability Verification Multiple Campuses PDF online today to ensure you receive the support you need.