Student Health & Accommodations Form

CBHS offers accommodations to current students with documented learning difficulties. In addition to in-school accommodations, CBHS offers assistance to students applying for accommodations on standardized tests with the College Board (PSAT, AP, SAT) and ACT (Pre-ACT, ACT).

Families interested in receiving accommodations for their son should complete and submit this form along with providing a psych-educational evaluation documenting the diagnosed learning difficulty.

All information on this report will be held in strict confidence. This will better help your son's counselor to assist him making the best possible use of his high school advantages. You may contact your son's counselor at any time to discuss this information.

TO BE COMPLETED BY THE PARENTS:

Student Information

Student First Name

Student Middle Name

Student Last Name

Street Address

City

State

Zip

Graduation Year

Student Date of Birth

Please upload proof of immunization documentation for the student.

Acceptable file types: .pdf, .docx, .jpg, .jpeg, .png

Drag and drop files here

Health Factors and Physical Conditions

Does your student have any health factors or physical conditions which could affect his scholastic progress or vocational choice. No

Does the student have a diagnosed learning disability? No

Parent Information

Parent First Name

Parent Last Name