Documentation Form Of Physical Disability - Student Development (Page 4 of 4) in pdf

Documentation Form Of Physical Disability - Student Development Page 4

Page 4 of 4

Documentation of Sensory,

Services for Students with Disabilities (SSD)

Physical and Medical Disabilities

Student Development Centre – Western University

If possible, please estimate how often the effects of the student’s disability may necessitate his or her

□

absence from classes:

< 1 day per month

2-5 days per month

>5 days per month

Is it your opinion that the student will be able to meet the demands of a full course load (15-25 hours of

□

lectures, labs, and/ or tutorial meetings per week plus 25-30 hours of study time per week?

yes

If you answer is no, please estimate the maximum amount of time that the student would be able to spend

in these activities: approximately ________________ hours per week.

Will you be monitoring this student on a regular basis while he or she is attending university?

□

yes

Are there situations or activities that may worsen this student’s condition?

Medication Information

Please list medications that the student is taking.

Adverse effects currently

Dosage and Frequency

experienced that may affect

Brand or Generic Name

academic functioning

Additional Information:

Thank you for taking the time to complete this form.

Documentation Form Of Physical Disability - Student Development Page 4