Major Life Activities Assessment: Please check each of the following major life activities that are impacted by the disability. Indicate severity of limitations. Life Activity Negligible Moderate Substantial Not Sure Concentrating     Memory     Eating     Social Interactions     Self-Care     Regular Class Attendance     Speaking     Learning     Reading     Thinking     Communicating     Keeping appointments     Stress Management     Managing internal distractions     Managing external distractions     Sleeping     Organization    
Major Life Activities Assessment: Please check each of the following major life activities that are impacted by the disability. Indicate severity of limitations. Life Activity Negligible Moderate Substantial Not Sure Concentrating     Memory     Eating     Social Interactions     Self-Care     Regular Class Attendance     Speaking     Learning     Reading     Thinking     Communicating     Keeping appointments     Stress Management     Managing internal distractions     Managing external distractions     Sleeping     Organization    
Disability-verification-form-in-word.docx