Get Psychological Disability Verification - Samuelmerritt

Filling out the psychological disability verification form is an important step for students seeking accommodations at Samuel Merritt University. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the form correctly.

1. Click the ‘Get Form’ button to access the psychological disability verification form. This will allow you to open the document in the editing interface.
2. Begin by entering the student's first name, middle initial (if applicable), and last name. Ensuring accuracy in these details is crucial for proper identification.
3. Next, fill in the date of birth. This helps to verify the identity of the student and is essential for the processing of accommodations.
4. In the section for DSM-IV-TR multi-axial diagnosis, complete Axis I with the appropriate diagnosis codes and the corresponding dates of diagnosis. This confirms the student's psychological condition.
5. If applicable, complete Axis II with relevant information regarding the student’s personality disorders. Then, provide details in Axis III regarding any other medical conditions affecting the student.
6. In Axis IV, outline any psycho-social and environmental stressors that may be impacting the student. This context can help the university understand the student's environment better.
7. Complete Axis V by indicating the current global assessment of functioning along with the highest global assessment of functioning recorded previously.
8. Describe the functional limitations and their severity as they pertain to educational tasks. This information is vital for determining specific accommodations.
9. Document any medications prescribed and detail any side effects or functional limitations that arise from these treatments. This insight can influence potential accommodations.
10. Suggest possible accommodations that could alleviate the impact of the disability or its treatment on academic tasks. These recommendations will inform the university's support strategies.
11. Indicate whether the documented diagnosis is permanent/chronic or temporary, providing the relevant date if it is temporary.
12. The certifying professional must complete their information, including name, signature, title, address, license number, city, state, zip, and phone number.
13. Finally, ensure all the information is accurate, save your changes, and prepare to submit the form as indicated. You may also download or print a copy for your records.

Complete your psychological disability verification form online today to begin the process of obtaining the necessary accommodations!