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Student health 101

Forms

Application and Request Forms

These forms are to be completed by students prior to service or release of information.

  Format
Student Request for Services webform
Quick Response Form webform
Release of Information PDF
Accommodation Appeal Review Form PDF
Confidential Student File Access Guidelines PDF
Student Request for Sign Language Interpreting or Live Transcription Services webform
Furniture Request Form

webform

Campus Physical Accessibility Needs webform

Documentation Forms

These forms are to be completed by a licensed professional.

  Format
Psychological Disability PDF
ADHD * PDF
Visual Disability PDF
Mobility and Medical Disability PDF
Hearing Impairment PDF
Learning Disability PDF

*Additional ADHD documentation is required in order to qualify for standardized testing accommodations and medication. Please visit AD/HD (Attention Deficit Hyperactivity Disorder) Documentation Guidelines for details.

Service Process and Responsibilities Forms

These forms are reviewed by students with their Access Specialists prior to receiving services.

  Format
Alternative Media PDF
Alternative Testing PDF
Assistive Listening Devices PDF
Classroom Furniture / Furniture Request Form PDF
LiveScribe Pen PDF
On-Campus Transportation PDF
Sign Language Interpreting PDF
Typewell Transcription PDF

Forms for Campus Faculty and Staff

These forms are to be completed by faculty or staff prior to service.

  Format
Request for Sign Language or Speech to Text Interpreting Services webform
Department Interpreting/Transcribing Agreement PDF

Accommodation APPEAL Process

As part of the California State University (CSU) system, Cal Poly is committed to ensuring equitable access to educational opportunities to qualified students with disabilities.  In both practice and policy, Cal Poly adheres to the requirements of the Americans with Disabilities Act of 1990, as amended 2008 (ADAAA); Sections 504 and 508 of the Rehabilitation Act of 1973, as amended; and all other federal and state laws and regulations prohibiting discrimination on the basis of disability.  To meet these regulations and statutes, the CSU system established the Policy for the Provision of Accommodations and Support Services to Students with Disabilities and Executive Order 1111: The California State University Policy on Disability Support and Accommodations.


Cal Poly’s Accommodation APPEAL Process may be initiated when a student is dissatisfied with an Access Specialist’s (AS) response to an accommodation request.  In conjunction with the accommodation appeal review, students shall notify the Disability Resource Center (DRC) of concerns as soon as possible. Students shall work collaboratively with the DRC to explore possible resolutions. A student must complete and file an Accommodation APPEAL form and submit it with supporting documentation to the Disability Resource Center. Documentation may include medical records that clearly support the requested accommodation as necessary due to the functional limitations associated with the student’s disability.


Students can complete an online copy of the Accommodation APPEAL Form or download a copy to print and return to the DRC. (PDF version/ Word DOCX version)


The DRC Director will review and evaluate the Accommodation APPEAL Form and supporting documentation, if any, and make a determination within ten (10) working days of receiving the appeal.


Current accommodations as determined by the Access Specialist will continue to be in effect, in order to provide access during the appeal review process, with any additional issues to be resolved as quickly as possible.


Students who are dissatisfied with the Disability Resource Center Director’s recommendation may file a Grievance.  (See GRIEVANCE Procedures for Disability Resource Services)   
 

Related Content

Contact

Location: Bldg 124 (Student Services, across from Spanos Stadium)
Phone: 805-756-1395
Fax: 805-756-5451
Email: drc@calpoly.edu

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