Please use this box to tell us how the diagnosed disability / medical condition described is currently impacting your functioning and causing you substantial limitations. 1. Considering the skills such as reading, writing, paying attention, mathematics, etc., describe (be specific) the current (or recent) impact of the disability/medical condition in both of the following areas: a. In Class - lectures, labs, test-taking, participation, etc. b. Out of Class - private study, time management, homework, daily living and accommodation/residence needs etc. 2. Accommodations/Services With reference to the above information, describe the accommodations, resources and services that you think you will need and how these will address the issues you have identified above. If a written response is difficult for you, you may record your responses and submit an audio file.