Forms and Guidelines

List of DSS Forms and Guidelines with Descriptions

Form Name Description
ADD/ADHD Verification 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.
Alternate Media Request Completed and submitted online by a student when requesting alternate media as an approved disability-related accommodation. Students will also need to provide specific information on their textbook(s) and proof-of-purchase.
Academic Accommodation Request 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.

Accommodated Test Instruction (blue test form)

Faculty may submit their exam and the instructions for administering this accommodated exam by the DSS office.
Accommodation Appeal Form Students who have been denied their requested accommodation(s) may request reconsideration of the decision by completing the Accommodation Appeal/Reconsideration Form.
Adaptive Furniture Guidelines Guidelines for the use of adaptive classroom furniture owned by DSS
Concussion Management Accommodation Request A student who has sustained a concussion may request accommodation services through DSS related to this temporary condition.
Consent for DSS 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.
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.
Dietary Accommodation Request Completed by a student and a qualified professional to document food allergies and special dietary requirements, including specific recommendations.
Exacerbation in Symptoms Accommodation Authorization Guidelines This accommodation is intended to accommodate students with disabilities who may experience periods of exacerbated symptoms associated with their disability, which may necessitate recurrent absences, and where there will be periods of reduced symptoms.
Furniture Request 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.
Health Provider Verification For Housing Accommodations Students who request disability-related housing accommodations must have a professional who is trained and qualified to document this condition, complete this form online.
Housing Accommodation Request Form Students may request disability-related housing accommodations if their functional limitations would otherwise prevent equal access to on-campus housing. After submitting your request please have a professional who is trained and qualified to document this condition.
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-Taking Accommodation Guidelines

Note-taking services are provided as a disability-related accommodation to eligible students registered with the Disability Services for Students (DSS) office who have a documented disability, which impacts the student's ability to effectively take notes in class.

Psychological & Neurological Disabilities Verification Completed by a professional who is trained and qualified to document this condition.
Reporting Concerns DSS welcomes any suggestions for improvement of services that will enhance the provision of our services to DSS students.
Student Information Form Students begin the process of registering for DSS services by completing and submitting the Student Information Form (Intake).
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.