Verification Form: Attention Deficit Hyperactivity Disorder
Section III: Provider’s Certifying Professional Information
(Please type information or print legibly)
Professionals conducting the assessment, rendering a diagnosis, and providing recommendations for reasonable
accommodations must be qualified to do so (e.g., licensed physician, psychiatrist, clinical psychologist). The provider signing this
form must be the same person answering the above questions. The person completing this form may not be a relative of the
student or hold power of attorney over the student.
Section IV: Submitting This Form
It is the responsibility of the student to submit this form to the Learning Specialist in the Accessibility Office (TAO) at
Bucks County Community College during their intake appointment when they register with TAO. Students will also be
required to meet with a Learning Specialist if they would like to update their accommodations using the verification
form or any other form of documentation.
Section V: How to Make an Intake Appointment
Students are encouraged to call or email the Accessibility Office (TAO) to schedule an appointment. Intake appointments
are only done in person. There are certain times of year that appointment waiting times can be up to six weeks. The
student identification number and Bucks email is required for students to obtain an intake appointment. Students are
encouraged to contact TAO as soon as possible to ensure that their accommodations are approved and put into place as
soon as possible. TAO’s contact information is as follows:
Phone: (215) 968-8182
Office: Bucks County Community College
275 Swamp Road
Rollins Center • Student Services Office • Room 001
Newtown, Pennsylvania 18940
Appointments can be scheduled for the Upper Bucks (Perkasie) and Lower Bucks (Bristol) campuses. TAO Learning
Specialists are on each of the satellite campuses one day per week. The student should inform the TAO team member if
they have a campus preference.
Information regarding the Accessibility Office (TAO), accommodations and assistive technology (AT) at Bucks County
Community College can be found at https://www.bucks.edu/resources/campusresources/accessibility/
. Please visit our
website for the latest information and updates as they are made available. If you have any questions, please feel free to
call us (215) 968-8182.
click to sign
click to edit