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The applicant provides identifying information, evaluation dates, consent to release disability and accommodation information, and signature. The qualified professional must supply credentials, describe diagnostic and treatment qualifications, document the applicant’s AD/HD history, current symptoms causing significant impairment for at least six months, childhood evidence, impairment across multiple settings, differential diagnosis, and the AD/HD subtype, supported by objective evidence.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/form-3-attention-deficithyperactivity-disorder-verification/320894/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/form-3-attention-deficithyperactivity-disorder-verification/320894.png","ImageObject",300,407,{"name":92,"@type":93},"Seraphina","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-23","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Who completes which parts of Form 3?","Question",{"text":113,"@type":114},"The applicant completes the applicant notice and consent section and signs. The remaining portions must be completed by the qualified professional recommending accommodations based on AD/HD.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What documentation must support the AD/HD diagnosis for accommodations?",{"text":118,"@type":114},"The form requires objective evidence for current symptoms causing significant impairment for at least six months and evidence that symptoms were present in childhood, with impairment observable in two or more settings and clinically significant impairment in the academic setting.",{"name":120,"@type":111,"acceptedAnswer":121},"How does the qualified professional determine the appropriate AD/HD subtype?",{"text":122,"@type":114},"The qualified professional must indicate the specific diagnostic subtype: predominantly inattentive type, hyperactive-impulsive type, combined type, or not otherwise specified.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},320894,1790179695,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":46},962075114101,"https://ap-avatar.wpscdn.com/avatar/e000253a75eb197efd?x-image-process=image/resize,m_fixed,w_180,h_180&k=1780044092746381165","FORM 3: ATTENTION DEFICIT/HYPERACTIVITY DISORDER  \nVERIFICATION  \nNOTICE TO APPLICANT: This section of this form is to be completed by you. The remainder of the form is to be completed by the qualified professional who is recommending accommodations on the bar examination for you on the basis of AD/HD. Please read, complete, and sign below before submitting this form to the qualified professional for completion of the remainder of this form.  \nApplicant’s full name:   Date(s) of evaluation/treatment:   Applicant’s date of birth:   [SSN] :    \nI give permission to the qualified professional completing this form to release the information requested on the form, and I request the release of any additional information regarding my disability or accommodations previously granted that may be requested by the [ IOACE] or consultant(s) of the [ IOACE] .  \nSignature of applicant Date  \nNOTICE TO QUALIFIED PROFESSIONAL:  \nThe above-named person is requesting accommodations on the Indiana Board of Law Examiners Bar Examination. All such requests must be supported by a comprehensive written evaluation report from the qualified professional who conducted an individualized assessment of the applicant and is recommending accommodations on the bar examination on the basis of AD/HD. The Indiana Board of Law Examiners also requires the qualified professional to complete this form. If any of the information requested in this form is fully addressed in the comprehensive evaluation report, you may respond by citing the  specific page and paragraph where the answer can be found.  \nThe Indiana Board of Law Examiners may forward this information to one or more qualified professionals for an independent review of the applicant’s request.  \nPrint or type your responses to the items below. Return this completed form, the comprehensive evaluation report, and relevant records and test results to the applicant for submission to the Indiana Board of Law Examiners.  \nI. EVALUATOR/TREATING PROFESSIONAL INFORMATION  \nName of professional completing this form:   Address:   Telephone:   Fax:    \nE-mail:   Occupation and specialty:    \nLicense number/Certification/State:    \nDescribe your qualifications and experience to diagnose and/or verify the applicant’s condition or impairment and to recommend accommodations.    \n\n|  |\n| --- |\n|  |\n\nII. DIAGNOSTIC INFORMATION CONCERNING APPLICANT  \n1. Provide the date the applicant was first diagnosed with AD/HD.    \n2. Did you make the initial diagnosis?  Yes  No If no, provide the name of the professional who made the initial diagnosis and when it was made, if known.  \n3. When did you first meet with the applicant?    \n4. Provide the date of your last complete evaluation of the applicant.    \n5. Describe the applicant’s current symptoms of AD/HD that cause significant impairment across multiple settings and that have been present for at least six months. Provide copies of  \nany objective evidence of those symptoms, such as job evaluations, rating scales filled out by third parties, academic records, etc.  \n6. Describe the applicant’s symptoms of AD/HD that were present in childhood or early adolescence (even if not formally diagnosed) that caused significant impairment across multiple settings. Provide copies of any objective evidence of those symptoms, such as report cards, teacher comments, tutoring evaluations, etc.  \n\n|  |\n| --- |\n|  |\n\nThe provision of reasonable accommodations is based on assessment of the current impact of the disability on the specific testing activity. The Indiana Board of Law Examiners generally requires documentation from an evaluation conducted within the last three years to establish the current impact of the disability. The diagnostic criteria as specified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) (or most current version) are used as the basic guidelines for determination of an Attention Deficit/ Hyperactivity Disorder (AD/HD) diagnosis. The di","cbCaifMGM8MngMay","https://ap.wps.com/l/cbCaifMGM8MngMay","pdf",279856,"English","# Applicant Notice and Consent\n# Evaluator/Treating Professional Information\n# Diagnostic Information Concerning Applicant\n## Current Symptoms and Impairment\n## Childhood Symptoms\n## Diagnostic Criteria and Subtype\n# Formal Testing Requirements","[{\"question\":\"Who completes which parts of Form 3?\",\"answer\":\"The applicant completes the applicant notice and consent section and signs. The remaining portions must be completed by the qualified professional recommending accommodations based on AD/HD.\"},{\"question\":\"What documentation must support the AD/HD diagnosis for accommodations?\",\"answer\":\"The form requires objective evidence for current symptoms causing significant impairment for at least six months and evidence that symptoms were present in childhood, with impairment observable in two or more settings and clinically significant impairment in the academic setting.\"},{\"question\":\"How does the qualified professional determine the appropriate AD/HD subtype?\",\"answer\":\"The qualified professional must indicate the specific diagnostic subtype: predominantly inattentive type, hyperactive-impulsive type, combined type, or not otherwise specified.\"}]","FORM 3 - ATTENTION DEFICIT/HYPERACTIVITY DISORDER - VERIFICATION | PDF",1789954884]