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This form is used to certify a student's Attention-Deficit Hyperactivity Disorder (ADHD) and determine their eligibility for services from the Disability Services for Students (DSS) office at Sonoma

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How to fill out certification of attention-deficit disorderhyperactivity

How to fill out Certification of Attention-Deficit Disorder/Hyperactivity Disorder

01

Obtain the Certification form from a reliable source such as your healthcare provider or school.

02

Fill in your personal details including name, date of birth, and contact information at the top of the form.

03

Provide a detailed description of your symptoms, including when they started and how they affect your daily life.

04

Include any previous diagnoses or evaluations related to Attention-Deficit Disorder/Hyperactivity Disorder.

05

Have your healthcare provider complete their section, detailing their qualifications and summarizing their assessment.

06

Attach any supporting documentation, such as test results or recommendations for treatment.

07

Review the completed form for accuracy and completeness before submission.

08

Submit the form to the appropriate institution or organization, such as a school or employer, and keep a copy for your records.

Who needs Certification of Attention-Deficit Disorder/Hyperactivity Disorder?

01

Individuals seeking to receive accommodations in an educational setting due to Attention-Deficit Disorder/Hyperactivity Disorder.

02

Students who require special services or support from their school.

03

Parents seeking documentation for their child's diagnosis to access healthcare or educational resources.

04

Adults applying for job accommodations or disability benefits related to their condition.

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What is Certification of Attention-Deficit Disorder/Hyperactivity Disorder?

Certification of Attention-Deficit Disorder/Hyperactivity Disorder is a formal document that verifies an individual's diagnosis of ADD or ADHD, typically required for educational accommodations or special services.

Who is required to file Certification of Attention-Deficit Disorder/Hyperactivity Disorder?

Individuals seeking accommodations for educational or medical needs, such as students in schools or patients in medical settings, are required to file this certification.

How to fill out Certification of Attention-Deficit Disorder/Hyperactivity Disorder?

To fill out the certification, one must provide personal information, a detailed description of the diagnosis, relevant medical evaluations, and recommendations for accommodations.

What is the purpose of Certification of Attention-Deficit Disorder/Hyperactivity Disorder?

The purpose is to establish the diagnosis of ADD or ADHD officially, ensuring the individual receives appropriate accommodations, support, and services based on their needs.

What information must be reported on Certification of Attention-Deficit Disorder/Hyperactivity Disorder?

The certification must report the individual's personal information, the diagnosis details, relevant symptoms, date of diagnosis, and recommended accommodations or interventions.

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