Recommended Documentation for Disabilities

In order to identify the most appropriate assistance we can offer, you must provide Jackson State with information from a qualified health care provider. It must be submitted before any adjustments are made.

Detailed documentation should be less than five years old and include:

 A disability must substantially limit one or more major life activities including, but not limited to, walking, seeing, hearing, speaking, breathing, learning, working, caring for oneself and performing manual tasks.

If you are not able to obtain such a report, you may submit one of the following forms to the appropariate health care provider to fill out completely. You should then return it to the Disability Resource Center staff.

Medical/Physical Disability Documentation Form

Psychological/Psychiatric/ADHD/Learning Disability Documentation Form

Learning Disability
Evaluation from a licensed school psychologist, licensed psychological examiner, licensed clinical psychologist, or neurophysiologist who is specialized in assessing learning disorders.
Attention Deficit Disorder (ADD/ADHD)

Comprehensive evaluation with clinical interview, historical data, psychological tests, clinical observations by a licensed school psychologist, licensed psychological examiner, licensed clinical psychologist, or neurophysiologist, who has speciaized training in assessing ADD/ADHD.

Psychiatric Disorder
Information from a licensed psychiatrist or licensed psychologist.
Physical Disability
A licensed physician’s report stating the diagnosis, explanation of physical limitations – including specific access needs, medical history, medications, and duration of condition.
Visual Impairment
Assessment from a licensed optometrist or ophthalmologist.
Hearing Disorder
Report from an audiologist with audiogram showing type and degree of hearing loss.
Traumatic Brain Injury
Evaluation by a licensed neurophysiologist, licensed orthopedic specialist, licensed speech-language pathologist, and/or other specialists as appropriate.