Verification Form: Diagnosed Psychological Conditions

Verification Form: Diagnosed Psychological Conditions

NOTE: This form is to be filled out, in its entirety, by the professional treating the student. This professional must be unrelated to the student, and any information provided by a family member will be considered supplemental. Forms with insufficient detail will prompt a request for more information. PLEASE TYPE AND SUBMIT THIS FORM ELECTRONICALLY, rather than handwriting or printing it out. You will be emailed an electronic copy of this information upon submission.