About Us

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
Note-Taking Request Form webform
Accommodation Appeal Review Form PDF
Confidential Student File Access Guidelines PDF
Assistive Technology Consultation/Alt Media Training webform
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
Department Interpreter/Transcriber Request webform
Department Interpreting/Transcribing Agreement PDF

Steps/Forms to Appeal a Denied Accommodation

  Format
  1. Students are encouraged to engage in the interactive process by completing the Accommodation Request Review Form (which may include a request for additional documentation)
PDF
  1. If the student is not satisfied with the outcome of the appeal, the student can meet with the Dean of Students who will assess the request and advise the DRC.
 
  1. If the requested accommodation is still not granted, students wishing to formally file an appeal should review the campus Policy and Procedures for Resolving University 504/ADA Student Accommodation Disputes.
Webpage
  1. If the student wishes to pursue a formal complaint, an Appeal/Accommodation Complaint Form must be filed with the Dean of Students within thirty (30) calendar days of the time the complainant could reasonably be expected to have had knowledge of the alleged discriminatory action.
PDF

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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