This form is designed to guide providers in sharing relevant information regarding the patient/client. While completing this form is not mandatory, it serves as a helpful tool to ensure that we have the information necessary to assess the student’s request and determine how we can best support their disability-related needs. We encourage you to provide clear and detailed responses that address the student's diagnosed condition. If you choose not to use this form, we welcome equivalent documentation that addresses similar points. Your collaboration is invaluable in helping us create an inclusive and supportive environment for all NCCU students. Note: This form and any accompanying documentation will only be used as part of the accommodation determination process and will remain confidential as outlined in our university policies.
Please print and use the General Provider Documentation Form (PDF) if you are unable to complete the online version of the form.