Online Forms

These forms may be completed and submitted online. You are encouraged to print out a copy for your records. When a form is submitted, you will receive an e-mail confirmation. If you do not receive the e-mail confirmation, it may be necessary to mail in a copy of the printout or to fill out the form and resubmit it electronically. All forms may also be picked up in the DSPS offices.

• Student Inquiry Form
  Complete this form if you are a student with a disability interested in attending Cuesta College and would like information sent to you.
  
• Alternate Media Request Form
  Complete this form if requesting course books and/or materials in an alternate format (i.e. audio, large print, braille, electronic).
  
• Alternate Media for Course Handouts Form
  Students with print disabilities who need course handouts in braille or electronic text should fill out this form.
  
• Evaluate the AS/DSPS Website Form
  Here is your opportunity to tell us what you liked or disliked about our web site, so we can make it better.
  
• Closed Captioning Request Form
  Instructors and Library staff, if there is a video tape you would like to see captioned, please fill out the this form and click the "submit form" button. If you are a student, please use the Alternate Media Request Form .

Offline Forms

These forms are available in Adobe PDF or MS Word file formats, and may be downloaded, printed out, filled in, and returned to the DSPS department. For more information on a topic, click on the info button.

Adobe Acrobat Reader may be downloaded from Adobe's Web Site. If you do not have Microsoft Word, a MS Word Viewer may be downloaded from Microsoft's Web Site

Application Forms

• Application for DSPS Services      
  Complete this form to Apply for DSPS Services.
  
  
• Consent for Release of Information Form      
  Complete this form along with the DSPS Application for Services.
   
• Verification of Disability Form     
  
  

DSPS Forms

• Service Animal Form   
  Complete this form if you plan to bring a service animal on campus.
  
  
• Indicators of Learning Disabilities Self Evaluation   
  Complete this survey to see if you have indicators of a learning disability.
  
  
• Request for Information to be Sent     
  Complete this form if requesting verification of your disability or other confidential information be sent (i.e. Verification of Disability, Cuesta College L. D. Assessment, Student Educational Contract, Educational Limitations).
  

Service Request Forms

• Adaptive Equipment Request Form     
  Complete this form to request the loan of adaptive equipment (i.e. four-track tape players, CD players, Perkins Brailler, QuickPad).
  
  
• Adaptive Furniture Request Form     
  Complete this form if requesting adaptive furniture for a classroom or lab (i.e. adjustable table, large chair).
  
  
• Alternate Media Request Form     
  Complete this form if requesting course books and/or materials in an alternate format (i.e. audio, large print, braille, electronic).
  
  
• Alternative Testing Request Form   
  This five part carbon form should be picked up in the DSPS testing office. It is only provided here for your information.
  
  
• Interpreter Request for Academic Appointment     
  Complete this form to request an Interpreter for an academic meeting.
  
  
• Notetaker Request Form     
  Complete this form to request a notetaker for a course.
  
  
• Taped Text Request Form     
  Complete this form if requesting course books on audio tape.

Academic Accommodation Forms

• Classroom Accommodation Agreement   
  Complete this form and submit it to your instructor if requesting permission to record lectures.
  
  
• Course Substitution/Waiver Request Form     
  Complete this form to petition for substitution/waiver of Associate Degree or certificate requirements based on a verified disability. You will also need to fill out the Good Faith Checklist.
  
  
• Good Faith Checklist     
  Complete this form to petition for substitution/waiver of Associate Degree or certificate requirements based on a verified disability. You will also need to fill out the Course Substitution/Waiver Request Form.

Faculty Forms

• LD Referral Form     
  Complete this form if you are a faculty member with a student who might have a disability, and who might benefit from the services of DSPS.

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Page maintained by dspsweb@cuesta.edu. Last modified: 02/19/2009.