1.      What is the applicant’s medical diagnosis (or diagnoses)?

2.      What is the expected duration of his/her diagnosed condition(s)?

3.      What, if any, corrective measures and/or medication is applicant pursuing to address his/her diagnosed condition(s)? 

4.      In light of the corrective measures and/or medication, if any, referenced in response to the above question, what, if any, of the applicant’s major life activities are substantially limited by his/her diagnosed condition(s)?  Please describe how each major life activity is substantially limited despite any corrective measures and/or medication.  If no major life activities are substantially limited, please so state.

 An impairment is substantially limiting when it renders a person unable to perform major life activities that the average person can perform, or when it significantly restricts the condition, manner, or duration under which he or she can perform the major life activity as compared to an average person.  29 C.F.R. § 1630.2(j)(1)(i) & (ii).  In determining whether an individual is substantially limited in a major life activity, the following three factors should be considered: (1) the nature and severity of the impairment; (2) the duration or expected duration of the impairment; and (3) the permanent long term impact, or the expected permanent or long term impact of or resulting from the impairment.  29 C.F.R. § 1630.2(j)(2).  You should provide your provider with this definition and ask the provider to specifically address these factors in setting forth what, if any, substantial limitations you have resulting from the diagnosis (es).

 5.      What, if any, specific reasonable accommodations are needed regarding the Police Officer tests?  Please include in your response, an answer to the following:

 If prolonged test taking time is recommended, please indicate the specific length of additional time that is needed for each test component described below.

 <Insert letter regarding police test times and tasks of a police officer.>

<Insert letter regarding fire test times and tasks of a firefighter.>