Durham Technical Community College
Disability Services Office
1637 Lawson Street /
Durham, North Carolina 27703
919
-536-7208 disabilityservices@durhamtech.edu
Visual Impairment Documentation Guidelines
Durham Technical Community College provides reasonable accommodations for students with a
documented visual impairment. Post-secondary students no longer have IEPs because the
Individuals with Disabilities Education Act (IDEA) does not exist at the college level; however, an IEP
may be included as part of a more comprehensive report. Durham Tech students are governed under
the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act, specifically
subpart E.
Durham Tech Disability Services Office will make the final determination of whether appropriate and
reasonable accommodations are warranted and can be provided for the individual. Students with
disabilities are expected to satisfy the academic standards required by the college and perform
essential course functions without substantially altering the curriculum requirements.
Student: Complete this release form and return to the Durham Tech Disability Services Office.
Be sure to complete the personal impact statement on the back of this sheet.
Student name: Date of birth:
Student ID number: Phone:
Address:
Signature: Date:
REQUIRED DOCUMENTATIONMust be current (within the past five years)
1. Documentation must be provided by an ophthalmologist, optometrist, or other licensed eye care
professional. All documentation must be submitted on the official letterhead of the professional
describing the disability. The report should be dated, signed and include the name, title, and
professional credentials of the evaluator.
2. Documentation should include a diagnosis and specify best corrected visual acuity and degrees
of visual field in each eye. Include the date of diagnosis, date of last visit, and severity of the
condition, as well as treatment history and treatment plan.
3. Describe the impact the impairment has on the individual’s visual ability and the functional
limitations it may impose. The impact should be discussed with particular detail regarding
academic requirements. Documentation consisting only of a diagnosis, chart notes,
and/or prescription pad notations is insufficient. Do not submit handwritten
documentation.
4. If specific recommendations of accommodations are made, the rationale must relate the
accommodation to the functional limitations imposed by the disability.
Evaluator’s name (please print):
Licensure/Certification: Date:
02/2016
click to sign
signature
click to edit
Impact Statement
Use this form to request disability accommodations. This form may be completed alone or with a
disability services staff member. You may attach additional pages if necessary. In addition to your
response, you may also ask others who currently know you or have observed you to submit answers
to these questions in a separate document.
Name: Date:
Email: Telephone:
Program of study: Student ID number:
Describe in as much detail as possible the diagnosed condition that is currently impacting and
substantially limiting your ability to learn.
Documented disability:
Describe in as much detail as possible how the diagnosed condition has impacted and substantially
limited your ability to learn in the recent past.
Current impact:
Describe the accommodations or services that you think you will need to be successful at Durham Tech.
Accommodations/Services: