General Students Seeking Assessment Services (ADD/ADHD/LD)

For students who may be seeking assessment services, the Heath Center is requesting that you complete the following steps:

For individuals who want to complete an assessment for Attention Deficit Hyperactivity Disorder and/or a Learning Disability and who are seeking educational accommodations from the University you should contact the Disability Coordinator and/or the designee to complete a Service Provider Referral Form and then go online to complete the Student Confidential Self-Report Form. Once these documents are completed, schedule a consultation session with the Educational Disability Testing Specialist in the Health Center. If the documentation supports a request for testing and the primary concern is a learning disability, you will complete an intake with the Health Center, if applicable; you will be referred to the Learning Resource Center for an additional intake in order to process your request for accommodations, if you are eligible for supports from the University.

Service Provider Referral Form:  This form is completed by the Disability Coordinator to document the reason for your referral for testing services, provides some preliminary background information to assist in the test battery development process and documents your response to formal and informal interventions. The packet also includes an authorization form that allows the Learning Resource Center to share information with the Health Center.

Student Confidential Self-Report: This form is completed by the student and will likely require collateral information from a parent, guardian or caregiver to provide information about the student’s early development, educational experiences and learning strengths and weaknesses. The data obtained from this document assists the evaluator with formulating and finalizing the reason for referral, focus of the testing question and diagnosis.  To access this report, click on the following link, complete the form online, print out the form,  and bring it to your appointment.

**Special Note:  If you open the file using Mozilla Firefox, the document will not be displayed correctly.  You need to click “Open With Different Viewer” found in the upper right hand corner.  This will open a dialogue box,  where you need to click on “Open with Adobe Reader”, and then click "OK".  This will allow you to access the correct form to fill out online.

General Form for Students