FORMS

Name Description

ADD/ADHD Documentation Form

Completed by a professional who is trained and qualified to document this condition.

Alternate Media Contract

Completed and submitted by a student after alternate media has been approved as a disability-related accommodation, which indicates that the student agrees to secure this information with regard to copyright restrictions of reproduced materials.
Completed and submitted online by a student when requesting alternate media as an approved disability-related accommodation. Student will also need to provide specific information on their textbook(s) and proof-of-purchase.
Students may request their accommodations letters without meeting with their DSS Advisor in situations where they have added additional classes after meeting with their DSS Advisor, for the WEPT, and with prior agreement with their DSS Advisor for on-going accommodations.
Faculty may submit their exam and the instructions for administering this accommodated exam by the DSS office.

Accommodation Appeal Form

Students may appeal decisions related to accommodation requests.

Concussion Management Accommodation Request

A student who has sustained a concussion may request accommodation services through DSS related to this temporary condition

Consent for Release of Information

A student may provide consent for DSS to speak with another individual or the student may request copies of their own records.
If a student would like his/her documentation released to an outside entity, then this request must be made directly to the professional who authored this report.

Consent to Obtain Information

A student may provide DSS with consent to obtain records from another organization or professional, or a student may request that DSS send the appropriate disability verification form to their professional for completion.

Dietary Accommodation Request

Completed by a student and a qualified professional to document food allergies and special dietary requirements, including specific recommendations.

ELM/EPT Request

A student may request disability-related accommodations for taking the English (EPT) and/or Math (ELM) placement exams
A student may complete and submit this online form to request that adaptive furniture be placed into the classroom as an approved disability-related accommodation (Form also available in PDF)

Interpreting and Captioning Guidelines

Students who are deaf or hard-of-hearing may request interpreting and/or real-time captioning services.

Learning Disabilities Guidelines

The California State University Guidelines for the “Assessment and Verification of Students with Learning Disabilities” outlines the essential requirements necessary for documenting a learning disability.

Medical Verification Form

This form may be completed by the student’s health care professional related to medical conditions other than ADD/ADHD, Psychological, learning disabilities (see other specific verification forms).

Note-taker Expectations

This document outlines the responsibilities of the student who has agreed to share their class notes, as well as the responsibilities of DSS student who has qualified to have note-taking assistance as a disability-related accommodation.

Psychological & Neurological Disabilities Verification Form

Completed by a professional who is trained and qualified to document this condition.
DSS welcomes any suggestions for improvement of services that will enhance the provision of our services to DSS students.

Special Consideration for Housing Assignment

Students may request disability-related housing accommodations if their functional limitations would otherwise prevent equal access to on-campus housing. A portion of this form must also be completed by a professional who is trained and qualified to document this condition.
Students begin the process of registering for DSS services by completing and submitting the Student Intake Form.
(Also available in PDF)

Temporary Disability Accommodation Request

A student who has sustained a temporary disability/injury may request accommodation services through DSS related to this temporary condition.

Temporary Disability Parking Application

Individuals who have sustained an injury impacting their mobility may request a 30-day temporary parking permit allowing the individual to park in spaces on campus designated for Disabled Persons (daily or semester parking permit also required).

Temporary Disability Parking Guidelines

These guidelines outline the process and conditions for accessing and utilizing the 30-day Temporary Disabled Parking Permit.

Testing Accommodation Guidelines

These guidelines outline the process and conditions for taking accommodated exams in the DSS office.