Forms & Downloads
Important Notes:
- These forms are optional – students may also submit comprehensive evaluation reports or letters from qualified professionals that meet our documentation guidelines
- Forms must be completed by qualified, licensed professionals who are not related to the student
- All forms should be submitted on official letterhead with the provider’s signature and credentials
Submission Information
Methods of Submission:
- Email: [email protected]
- In Person: Jeffries Hall, Room 130
- Mail: Office of Accessibility Services, Georgian Court University, 900 Lakewood Avenue, Lakewood, NJ 08701
Documentation Guidelines:
For detailed information about documentation requirements for each disability category, please visit our Documentation Guidelines page.
Confidentiality:
All documentation submitted is maintained securely and confidentially in compliance with:
- Family Educational Rights and Privacy Act (FERPA)
- Americans with Disabilities Act (ADA)
- Section 504 of the Rehabilitation Act
Available Forms
Medical Verification Form
Purpose: For students with chronic medical conditions, neurological conditions, or mobility impairments
This form should be completed by a licensed healthcare provider to document:
- Current diagnosis and medical history
- Functional limitations in an academic setting
- Current treatments and medications
- Specific accommodation recommendations
Who Should Complete: Licensed physicians, nurse practitioners, or other qualified medical professionals
Psychological Verification Form
Purpose: For students with psychological or mental health conditions
This form should be completed by a qualified mental health professional to document:
- DSM-5 diagnosis and clinical assessment
- Functional impact in academic settings
- Current treatment and medications
- Recommended accommodations and rationale
Who Should Complete: Licensed psychologists, psychiatrists, or licensed clinical social workers
ADHD/ADD Verification Form
Purpose: For students with Attention-Deficit/Hyperactivity Disorder
This form should be completed by a professional experienced in diagnosing ADHD/ADD to document:
DSM-5 diagnosis and developmental history
Assessment procedures used
Functional limitations affecting academic performance
Medication management and accommodation recommendations
Who Should Complete: Clinical psychologists, neuropsychologists, psychiatrists, or medical doctors with ADHD expertise
Autism Spectrum Disorder Verification Form
Purpose: For students on the autism spectrum
This form should be completed by a professional with training and expertise in autism spectrum disorders to document:
- DSM-5 autism spectrum disorder diagnosis
- Assessment tools and procedures used
- Current functional limitations
- Academic accommodations and support recommendations
Who Should Complete: Psychologists, psychiatrists, neurologists, or other qualified clinicians with autism expertise
Online Grievance Form
Purpose: For students who believe they have experienced discrimination or failure to accommodate
This form allows students to file a formal grievance regarding:
Denial or delay of accommodations
Failure to implement approved accommodations
Discrimination based on disability
Inaccessibility of campus facilities or programs
Who Should Complete: Students registered with Accessibility Services
Need Help?
For Students: If you need assistance completing these forms or have questions about the accommodation process, please contact:
- Phone: 732-987-2646
- Email: [email protected]
For Healthcare Providers: If you are a healthcare provider and need clarification about documentation requirements or accommodation recommendations, please feel free to contact our office directly.
Office Information:
- Location: Jeffries Hall, Room 130
- Phone: 732-987-2646
- Email: [email protected]
- Office Hours: Monday – Friday, 8:00 am – 5:15 pm
