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1. Student s Name Date of Birth 2. What is your DSM-IV multi-axial diagnosis for this student Axis I Axis V GAF score 3. Counseling Center Disability Services Concordia College Academy 106 901 South 8th Street Moorhead MN 56562 PHONE 218-299-3514 FAX 218-299-4557 www. In order to determine eligibility for services we require documentation of the student s Attention-Deficit/Hyperactivity Disorder ADHD. Concordiacollege. edu/counseling REQUEST FOR DOCUMENTATION VERIFICATION OF...
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