Required Documentation for Hearing Disability

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Documentation is considered a confidential student record protected under all applicable state and federal privacy laws.

Please provide the following information:
 

1. Student's Name;

2. Date of Birth;

3. Printed Name and Signature of Certifying Professional;

4. License Number;

5. Business Address;

6. Business Phone Number; and

7. Business Fax number

Documentation should include:

1. Clear, concise description of hearing impairment (i.e., severity, date of onset);

2. Functional limitations as they pertain to an academic environment; 

3. A copy of the most recent audiogram; and
4. Suggested accommodations.

All documentation is confidential and should be submitted to:

UC Merced Disability Services
5200 N. Lake Rd., SSB 230
Merced, CA 95343
Phone: 209-228-6996
Fax: 209-228-4661