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

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

Oh oh ....

We are sorry but it appears that JavaScript is disabled on your browser.
Our site is very interactive and it requires JavaScript to be enabled.
Click on the link below for instructions on how to enable JavaScript on your browser.

Enable JavaScript on your browser