Get Functional Limitation Assessment Form - Seneca College

Filling out the Functional Limitation Assessment Form is an essential step for students seeking academic accommodations due to disabilities. This guide provides clear, step-by-step instructions for completing the form online, ensuring users understand each section's purpose and requirements.

Follow the steps to complete the form effectively.

1. Press the 'Get Form' button to access the Functional Limitation Assessment Form and open it for editing.
2. Complete the student section by providing your name, date of birth, address, and student number. This information must be accurate and up-to-date to ensure proper processing.
3. Indicate whether you consent to disclose your disability diagnosis by checking the appropriate box. Sign and date the form to confirm your consent.
4. In the student consent for release of information section, provide your full name and sign to authorize the health care practitioner to disclose necessary information to Counselling and Accessibility Services.
5. The regulated health care professional will complete their section of the form. They should clearly print their name and provide information regarding your functional limitations and any medications impacting your academic performance.
6. Section 1 requires the health care professional to confirm your disability status, indicating whether it is permanent or temporary and providing details regarding your condition's duration.
7. In Section 2, the health care professional will identify if any prescribed medications negatively affect your academic functioning, marking the applicable times.
8. Section 3 focuses on assessing the functional impact of your disability in various academic areas. The health professional will use a chart to rate your abilities across several skills.
9. Finally, the health care professional will complete the health practitioner authorization section, including their signature, date, and license number before returning the form to you.
10. After the form is completed, save your changes and download or print a copy for your records. You may submit the form to Counselling and Accessibility Services via fax or email.

Complete your Functional Limitation Assessment Form online today to ensure you receive the appropriate academic accommodations.