Impairment and Disability Assessment

* required fields

In order for Barry University to provide disability-related services, we need to establish that this student has a disability. A disability is defined as impairment substantially limiting a major life activity. This form is designed to help us make that assessment. Please respond to the following items.


Impairment Assessment

Major life activities assessment
  • Please check any of the major life activities listed below that are affected as a result of the impairment.
  • Please indicate the level of limitation.
1 = Negligible2 = Moderate3 = Substantial


Declaration
I hereby declare that the information provided in this form is true

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