Verification Form

SAS Verification Form

This form is to be filled out, in its entirety, by a qualified health professional who is currently treating the student. This professional must be unrelated to the student. Forms with insufficient detail will prompt a request for more information. Providers outside of Dartmouth College will also need to upload a brief, signed letter on letterhead.

For learning, attention, and autism spectrum diagnoses, a complete psychoeducational or neuropsychological evaluation is preferred in lieu of completing this form. SAS may also request copies of lab tests or other assessment measures.

Student Information
Provider Information
Summary of Current Care
Please be mindful that Dartmouth has a compressed, ten-week quarter system.
Historical/Assessment Information
Supplemental Accommodation Request Information
These recommendations may be included in the signed letter you upload below and must be accompanied by an explanation of their relevance to the student’s condition. Final determination of appropriate accommodations will be made by SAS.
We invite you to submit any other relevant documentation, such as test results or medical/case notes as well. (Acceptable file types are PDF and Word documents)
Files must be less than 2 MB.
Allowed file types: pdf doc docx odt.