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Online forms: Office of Disability Services Certification of Psychological Disability


The student named below has applied for services from the Office of Disability Services at Butler Community College. In order to determine eligibility and to provide services, we require documentation of the student’s psychological disability.

Under the Americans with Disabilities Act (ADA) of 1990 and Section 504 of the Rehabilitation Act of 1973, individuals with disabilities are protected from discrimination and may be entitled to reasonable accommodations. To establish that an individual is covered under the law, documentation must indicate that a specific disability exists and the disability limits one or more major life activities. A diagnosis of a disorder in and of itself does not automatically qualify an individual for accommodations. The documentation must also support the request for accommodations.

After completing this form, please mail it to us at the address below:

Butler Community College
Director of Disability Services
901 S. Haverhill Rd.
El Dorado, KS 67042

The information that you provide will be kept in the student’s file in the disability Services Office where it will be held strictly confidential. This form may be released to students upon request. In addition to the requested information, please attach any other information you think would be relevant to the student’s academic process. Please contact us if you have questions or concerns. Thank you for your assistance.