Best Practice
How Healthcare Providers Can Better Support College Accommodation Requests
Based on Conversations with
Megan Arbour, PhD, CNM, CNE, FACNM
Frontier Nursing University
Joanne Keefe, DNP, MPH, FNP-C, CNE
Frontier Nursing University
Maria Milazzo, PhD, RN, CPNP-PC
Stony Brook School of Nursing
Accommodation requests in college often require medical documentation, and yet health care professionals may not have a clear understanding of what is needed in order to ensure a successful accommodations request. Furthermore, unclear medical documentation can delay the process for students, leading to delays if not denial of accommodations requests.
The Solution
Health care professionals, including nurse practitioners, play a critical role in the journey towards accommodations and access in higher education. This blog post summarizes recent conversations with nurse practitioner advocates about this issue and what health care providers need to know about their role in providing needed documentation for an accommodations request.
Q&A
Q: Why is medical documentation so critical for college accommodations?
Colleges require current, comprehensive documentation that establishes both diagnosis and functional impact, but what one university office accepts, another might reject. The language healthcare providers use directly determines whether students get approved. A generic statement like “this student has ADHD and needs accommodations” carries far less weight than a detailed explanation of how ADHD specifically impacts the student’s ability to focus during activities such as three-hour exams or processing information in large lecture halls. Documentation that captures the range of academic tasks and activities are more likely to be successful than a generic letter.
Q: What are the most common documentation problems you’re seeing?
We see several recurring issues. Many students arrive at college with neuropsychological evaluations that accurately diagnose their condition but fail to specify what accommodations would address functional limitations in college. Others have generic letters describing their diagnosis without explaining how it impacts learning. There’s confusion about whether diagnostic letters from K-12 schools carry the same weight as those from medical professionals. Perhaps most concerning, families face significant cost barriers when colleges demand updated testing that can cost $2,000 to $5,000. When families can’t afford new evaluations, students simply go without accommodations.
Q: What gives you hope about the future?
We’re seeing increased awareness of neurodiversity, growing recognition of invisible disabilities like anxiety and ADHD, and strong student-led advocacy movements. Technology continues creating new accessibility solutions, and more institutions are questioning why campuses aren’t designed inclusively from the start.
Q: What can health care providers do right now?
Healthcare providers should evaluate their current documentation practices and ask: Would a disability resource professional understand exactly how this student’s condition impacts academic functioning? Families should start transition conversations in middle school, not senior year. Students should share their experiences to help inform better practices. Every reader has the power to contribute to meaningful change that improves outcomes for students with disabilities.
For Healthcare Providers: Enhanced training on writing effective disability documentation should be integrated into nurse practitioner programs and continuing education. Professional organizations need to develop specific guidelines for supporting students through this transition.
For Colleges: More proactive outreach to incoming students with disabilities, including personalized welcome packets, summer bridge programs, and connections with peer mentors before classes begin.
For Policy: Better continuity mechanisms between K-12 and higher education that don’t require students to start from scratch proving their disability while respecting student privacy and autonomy.
Common Accommodations
Learning Disabilities (Dyslexia, Dyscalculia):
Extended test time, audio textbooks, alternative format materials; diagnosed through psychoeducational evaluations
ADHD:
Reduced-distraction testing environments, note-taking assistance, deadline extensions; diagnosed by psychiatrists, psychologists, or primary care providers
Mental Health Conditions (Anxiety, Depression):
Flexible attendance policies, reduced course loads, priority registration; diagnosed through psychiatric evaluation
Autism Spectrum Disorder:
Social skills support, clear written instructions, structured environments; diagnosed by psychologists or developmental specialists
Chronic Health Conditions (Diabetes, Epilepsy):
Housing accommodations, excused absences for medical appointments, ability to take breaks; diagnosed by relevant medical specialists
Physical Disabilities:
Mobility accommodations, accessible housing, transportation services; documented by physicians or specialists
Practical Recommendations
What Healthcare Providers Can Do:
Essential Elements of Effective Accommodation Letters:
- Clear diagnostic information with current DSM codes and diagnosis date
- Specific functional limitations describing exactly how the condition impacts academic performance (e.g., “difficulty sustaining attention during extended testing, with significant decline after 45 minutes” rather than “has trouble concentrating”)
- Recommended accommodations with rationale explicitly linking each accommodation to documented limitations
- Chronicity and stability explaining whether this is ongoing or temporary
- Provider credentials and contact information establishing credibility and allowing follow-up
Actions During Routine Clinical Visits:
- Make educational functioning a standard part of assessments alongside sleep and nutrition
- Start transition conversations by sophomore or junior year of high school
- Document which specific accommodations are working and their impact on academic performance
- Create longitudinal records of accommodation effectiveness for future reference
- Coordinate with school teams when appropriate (with proper consent)
- Consider attending IEP meetings for patients when feasible
Proactive Transition Planning:
- Begin discussions at age 14 when students start attending their IEP meetings
- Educate families about fundamental differences between IDEA and ADA systems
- Explain that college requires self-advocacy and independent navigation
- Help students practice articulating their needs and accommodation rationale
- Connect families with disability advocacy organizations and college preparation resources
- Provide comprehensive documentation well before college application deadlines
What Healthcare Providers Should NOT Do:
Resource List
The Alliance for Disability in Health Care Education provides educational competencies and training materials for healthcare providers.
The National Association of Pediatric Nurse Practitioners and the American Association of Nurse Practitioners offer professional development opportunities related to supporting students with disabilities.
The Association on Higher Education and Disability is the premier organization for disability resource professionals and offers insights into documentation requirements.
The National Center for College Students with Disabilities provides research, policy briefs, and practical tools.
Professional continuing education courses on writing effective accommodation letters are increasingly available through nursing organizations and online platforms.