Get University Of California Berkeley Certification Of Attention-deficit Disorder/hyperactivity Disorder 2013-2025

This guide provides step-by-step instructions for completing the University Of California Berkeley Certification Of Attention-Deficit Disorder/Hyperactivity Disorder. Following these instructions will help ensure that you accurately fill out the form to support students seeking services.

Follow the steps to complete the certification form online

1. Click ‘Get Form’ button to access the certification form and open it in your preferred online editing tool.
2. Fill in the student’s name and UC Berkeley Student ID number in the designated fields. Ensure correct spelling and accuracy, as these details are essential for the processing of the application.
3. Enter the current date in the format Month/Day/Year. This information helps track the application timeline.
4. Provide all relevant diagnostic information in the DSM-5 section, selecting the appropriate ADHD diagnosis from the options provided. Be thorough in your descriptions and ensure they align with clinical standards.
5. Record the date of the diagnosis, ensuring accuracy in Month/Day/Year format. This is critical in establishing the timeline of the student's condition.
6. Document the date the student was last seen. This information is vital for assessing the continuity of care and support.
7. In the section provided, check all relevant items that contributed to the diagnosis. Include notes to help inform the types of assistance the student may need.
8. Describe the academic limitations and severity of symptoms experienced by the student. Use the provided scales to indicate the level of impact each area has on the student’s educational experience.
9. Indicate whether the student is currently taking medications for ADHD and provide details, including descriptions, prescriptions, and effects on academic functioning.
10. Specify if the student is currently in treatment with the professional completing the form. This information supports ongoing care collaborations.
11. Provide any additional information that may be pertinent for the review team regarding the student’s situation or needs.
12. Sign and date the form as the certifying professional. Include name, title, license number, address, and contact details to validate the submission.
13. The student must sign and date the authorization section at the end of the form, allowing for the coordination of care services.
14. Once all fields are completed, save your changes. You can then download, print, or share the form as needed for submission.

Complete your certification form online today to ensure students can access the necessary support services.