Forms and Guidelines for Disability Documentation

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Medical Disability Verification Form (PDF)

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Ophthalmological Certification Form (PDF)

Consent To Release Information Form (PDF)

Learning Disability Documentation Guidelines & Assessment Applications

 

Guidelines for Disability Documentation

Please refer to specific guidelines for Learning Disabilities and Attention Deficit/ Hyperactivity Disorder.  

The following guidelines are provided to ensure that documentation of disability submitted to the Accessible Education Center is appropriate to both verify disability and to support requests for accommodations, academic adjustments, and/or auxiliary aids.

It is the policy of San José State University to provide appropriate accommodations to students who have documentation indicating a claimed disability as defined under The ADA Amendments Act of 2008 (ADAAA). The following guidelines are provided to assist students in submitting clinical documentation to the Accessible Education Center:

  1. A diagnosis must be submitted on letterhead and determined by a licensed physician, primary health care provider, psychologist, audiologist, speech therapist, learning disability specialist, or other appropriate treating professional.
  2. Documentation must include an evaluation of the impact of the diagnosed condition and/or any prescribed medications on the individual. The documentation should include information regarding the manner, degree, and duration of the disability(ies) and any functional limitation(s) that are directly linked to and support the need for the requested accommodations.
  3. The Accessible Education Center has the discretion to determine the necessary professional documentation, depending upon the nature and extent of the disability as well as the accommodations requested. The University is not required to fundamentally alter or modify curriculum requirements.
  4. The receipt of services in a previous educational environment does not automatically guarantee identical services will be provided at San José State University.

The Accessible Education Center purges student files after five (5) years of inactivity in the San José State University system.

 

Learning Disability Documentation Guidelines and Assessment Applications

Students are responsible for providing documentation that supports the learning disability diagnosis and provides justification for the requested  accommodation(s). Documentation should reflect the current impact of the learning disability in the student’s academic life and the functional limitations resulting from the learning disability (i.e.: an inability to take comprehensive course notes due to memory deficits).

The testing process should utilize current, technically adequate and appropriate standardized instruments and should be based on a thorough examination of the student in the following areas. Any revisions or successors to the tests listed below would be included upon publication.

In most cases, current means testing that has been conducted within the past three years. Because the provision of all reasonable accommodations and services is based upon assessment of the current impact of the student's disabilities on his/her academic performance, it is in a student's best interest to provide recent and appropriate documentation. In the case of adults tested after age of 21, testing more than five years old will be re-evaluated.

The Diagnostic Interview

Because learning disabilities are most commonly manifested during childhood, educational history about learning difficulties in elementary, secondary and post-secondary education must be included. An evaluation report must also include a comprehensive diagnostic interview by a qualified evaluator who addresses relevant background information to support the diagnosis. Such information may include:

  • Developmental history
  • Academic history including results of prior standardized testing, and notable trends in academic performance
  • Family history
  • Psychosocial history
  • Medical history, including the absence of a medical basis for the present symptoms
  • History of prior and present psychotherapy and pharmaceutical-therapy
  • Discussion of any dual diagnosis of alternative or co-existing mood, behavioral, neurological and/or personality disorders
  • A description of the presenting learning problem(s).

The Neuropsychological or Psychoeducational Evaluation

The neuro psychological or psycho educational evaluation for the diagnosis of a specific learning disability must be submitted on letterhead of the qualified professional and it must provide clear and specific evidence of a learning disability. It is not acceptable to administer one test, nor is it acceptable to base a diagnosis on only one of the several sub-tests. Objective evidence of a substantial limitation to learning must be provided. Minimally, domains to be addressed must include the following:

Aptitude/Cognitive Ability

This list is not intended to be definitive or exhaustive. 
A complete and comprehensive intellectual/cognitive assessment is required. This may include, but is not limited to, the following:

  • Wechsler Adult Intelligence Scale-Third Edition (WAIS-III)
  • Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV)
  • Woodcock-Johnson-Third Edition: Tests of Cognitive Ability (WJ-III)
  • Kaufman Adolescent and Adult Intelligence Test
  • Reynolds Intellectual Assessment Scale (RIAS)
  • Stanford-Binet (SB5)
  • Test of Non-Verbal Intelligence (TONI-3)

The Slosson Intelligence Test-Revised and the Kaufman Adult Intelligence Test do not constitute adequate intelligence test measures.

Information Processing

Specific areas of information processing (e.g., short-term memory, working memory, long-term memory, sequential memory, auditory and visual perception/processing, processing speed, executive functioning, psychomotor ability) should be assessed as the information processing deficit and it must have the logical nexus that explains the academic difficulty. Acceptable instruments include the following, but are not limited to:

  • Wechsler Memory Scale
  • Rey Osterrieth Complex Figure
  • Trails A & B
  • Peabody Picture Vocabulary Test-Third Edition (PPVT-III)
  • Rey Auditory Verbal Learning Test
  • Bender Visual-Motor Gestalt Test
  • Beery Visual-Motor Integration Test
  • Wisconsin Card Sorting Test

Other instruments relevant to the presenting learning problems may be used in conjunction with one or more of the aptitude tests named above.

Achievement

A complete achievement battery is required with all sub-tests and standard scores. The battery must include current levels of academic functioning in reading (decoding and comprehension), mathematics, and written language. Acceptable instruments include, but are not limited to:

  • Woodcock-Johnson-Third Edition: Tests of Achievement (WJ III)
  • Wechsler Individual Achievement Test (WIAT III)
  • Test of Written Language-2 (TOWL-2)
  • Gray Oral Reading Test (GORT 4th ed.)
  • Spadafore Diagnostic Reading Test
  • Woodcock Reading Mastery Test-Revised
  • Stanford Diagnostic Mathematics Test

The Wide Range Achievement Test- Revised (WRAT 3 or 4) is not a comprehensive measure of achievement, and therefore is not acceptable if used as the sole measure of achievement. The Nelson-Denny Skills Test (Form G& H) is not a sole appropriate diagnostic measure of reading achievement. It is a useful screening instrument when administered under standardized conditions, but it should not be used as a basis for diagnosis.

The Report Must Include A Specific Diagnosis

  • Individual "learning styles", "learning differences", and "academic problems" in and of themselves do not constitute a learning disability. The nature and severity of the functional limitation(s) must be supported by the test data, academic history, anecdotal and clinical observations that may include the student's level of motivation, study skills, and other non- cognitive factors. These findings must support the fact that individual's functional limitations are due to the stated disabilities.
  • The report must indicate what steps were taken to evaluate the impact of second language issues to rule out the possibility that second language difficulties are a cause of the academic problems.

Actual Test Scores Must Be Provided

Standard scores must be provided for all normed measures. Percentiles are also acceptable; grade equivalents are not acceptable unless standard scores and/or percentiles are also included. The assessment must show evidence of discrepancies and intra-cognitive differences. The particular profile of the student's strengths and weaknesses must provide a rationale for the accommodations that are recommended.

Tests Used To Document Eligibility Must Be Technically Sound

The tests used must be reliable, valid and standardized for use with an adult population. The test findings should document both the nature and severity of the learning disabilities.

A Description Of Requested Accommodations Including The Rationale Must Be Provided.

The diagnostic report must include specific recommendations for accommodations and relevant recommendations regarding the curriculum, as well as testing considerations. A detailed explanation must be provided as to why each accommodation is recommended and should be correlated to specific test results or clinical observations. If any accommodation or auxiliary aid was provided in the past, it should be discussed; including information about specific conditions under which the accommodations were used (e.g. standardized testing, final exams, national board examination) and whether or not they benefited the student. For example, if the diagnosed condition is a learning disability, what is the processing disorder, and what is the relationship between the disorder and the requested accommodation? Any school plan (e.g. IEP or 504 plan) is not sufficient in and of itself, but can be included as part of a more comprehensive assessment battery as described in this document.

Documentation for students who have been determined eligible for accommodations and support services according to the criteria established by the California Community College system will be reviewed in accordance with the above prescribed CSU methodology and criteria.

If no prior accommodations have been provided, the qualified professional and/or student should include a detailed explanation as to why no accommodations were used in the past and why accommodations are needed at this time.

A Qualified Professional Must Conduct The Evaluation

Professionals conducting assessment and rendering diagnoses of specific learning disabilities must be qualified to do so. Experience in working with an adult population is essential.

Does your documentation not meet the guidelines?

On a case-by-case basis, the AEC provides Learning Disability assessment for the following categories. Please note: You must be a currently matriculated SJSU student to be considered for a Learning Disability Assessment done in the AEC.  If you are seeking learning disability assessment, please complete the learning disability assessment application that best corresponds to your current scenario:

My documentation is not current (3-5 years old).

Students in need of updating existing Learning Disability documentation must complete the Learning Disability Assessment Application. Please print and fill out the application in its entirety, completed applications are to be returned to Accessible Education Center, Administration Building, Room 110. Once your application has been submitted, the AEC's Educational Psychologist will review the application and contact you.

My documentation does not meet the requirements for Learning Disability verification at the post-secondary level.

Students who have submitted Learning Disability (LD) documentation that does not meet the California State University requirement for LD verification must complete the Learning Disability Assessment Application to request additional assessment. Please print and fill out the application in its entirety, completed applications are to be returned to Accessible Education Center, Administration Building, Room 110. Once your application has been submitted, the AEC's Educational Psychologist will review the application and contact you.

I have never been tested for a learning disability before, and I wish to determine the presence of a learning disability.

Students requesting Learning Disability assessment must complete a comprehensive Learning Disability Intake/Assessment Application. Please print and fill out the application in its entirety, completed applications are to be returned to Accessible Education Center, Administration Building, Room 110. Once your application has been submitted, the AEC's Educational Psychologist will review the application and contact you.

 

Guidelines for Attention Deficit/ Hyperactivity Disorder Documentation

The following guidelines are provided to assure that documentation of disability submitted to the Accessible Education Center (AEC) is appropriate to both verify disability and to support requests for accommodations, academic adjustments and/or auxiliary aids.

It is the policy of San José State University to provide appropriate accommodations to students who have a documented disability of Attention Deficit Disorder or Attention Deficit with Hyperactivity Disorder (AD/HD). To establish eligibility for services students must present documentation which meets the following criteria:

  1. Diagnosis must be determined by a clinician with expertise in the diagnosis of AD/HD. Qualified professionals are presumed to be psychologists, neurologists, or psychiatrists who have training and experience in the diagnosis and treatment of AD/HD.
  2. Documentation must include clinician's name, title, license number, phone number and address; summary of all instruments and procedures; date(s) of diagnosis and examination.
  3. Documentation must be comprehensive and include evidence of early impairment as well as evidence of current impairment. The following information should be included in a comprehensive assessment:
    • Historical information establishing symptomology indicative of AD/HD throughout childhood, adolescence and adulthood (i.e.: teacher comments, tutoring evaluations, psychoeducational testing, third party interviews)
    • Student’s presenting attentional symptoms should provide demonstrating evidence of ongoing impulsive/hyperactive behaviors which significantly impair functioning
    • Diagnostic interview summary should include but not be limited to the following:
      1. history of presenting attentional symptoms
      2. ongoing behaviors that have significantly impaired functioning
      3. psychoeducational evaluations
      4. description of functional limitations relevant to an educational related setting
    • The diagnostic report must include a specific diagnosis of AD/HD following the
      DSM-IV diagnostic criteria.
  4. The student’s assessment must demonstrate the current impact of the AD/HD in the academic environment and support the student’s need for accommodations and auxiliary aids. Accommodation recommendation by the evaluator should include a rationale.