Documentation Letter Template

Your Health Care Provider’s Letterhead
[Date]

To Whom It May Concern: 

I am the treating [job title or description, such as physician, psychiatrist, psychologist, therapist, social worker, case worker, or health care professional] for [student's name]. 

[Student] has [name or description of student’s condition], a condition that limits major life activities and academic work, including [list ways that work is affected]. 

[You may choose to include current treatments and strategies that could/should inform ​accommodations, such as assistive technology or devices already in use, medications with side effects that may also necessitate accommodations in themselves, etc.]

As a result of [Student]'s disability, she/he/they/ze seeks accommodations from The Graduate Center, CUNY, which include:

  •  
  •  
  •  

These accommodations will improve access for the student in the following ways: [list ways that accommodations address limitations].

Signature and license number​​