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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.


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.

Application Forms

  • Application for DSPS Services  DSPS Application PDF file  DSPS Application Word file  DSPS Application Information
    Complete this form to Apply for DSPS Services.

  • Consent for Release of Information Form  Consent for Release of Information PDF file  Consent for Release of Information Word file  Consent for Release of Information, Information
    Complete this form along with the DSPS Application for Services.
     
  • Verification of Disability Form  Verification of Disability PDF file  Verification of Disability Word file  Verification of Disability Information

DSPS Forms

  • Service Animal Form  Service Animal PDF file  Service Animal Word file
    Complete this form if you plan to bring a service animal on campus.

  • Indicators of Learning Disabilities Self Evaluation  LD Self Eval PDF file  LD Self Eval Word file
    Complete this survey to see if you have indicators of a learning disability.

  • Request for Information to be Sent  Request Information Sent PDF file  Request Information Sent Word file  Request Information Sent, Information
    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  Equipment Request PDF file  Equipment Request Word file  Equipment Request Information
    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  Furniture Request PDF file  Furniture Request Word file  Furniture Request
    Complete this form if requesting adaptive furniture for a classroom or lab (i.e. adjustable table, large chair).

  • Alternate Media Request Form  Alt Media Request PDF file  Alt Media Request Word file  Alt Media Request Information
    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  Alt Testing PDF file  Alt Testing Information
    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  Interpreter Request PDF file  Interpreter Request Word file  Interpreter Request Information
    Complete this form to request an Interpreter for an academic meeting.

  • Notetaker Request Form  Notetaker Request PDF file  Notetaker Request Word file  Notetaker Request Information
    Complete this form to request a notetaker for a course.

  • Taped Text Request Form  Taped Text Request PDF file  Taped Text Request Word file  Taped Text Request Information
    Complete this form if requesting course books on audio tape.

Academic Accommodation Forms

  • Classroom Accommodation Agreement  Class Accommodation Agreement PDF file  Class Accommodation Agreement Information
    Complete this form and submit it to your instructor if requesting permission to record lectures.

  • Course Substitution/Waiver Request Form  course substitution waiver PDF file  course substitution waiver Word file  course substitution waiver information
    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  Good Faith PDF file  Good Faith Word file  Good Faith Information
    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  LD Referral PDF file  LD Referral Word file  LD Referral Information
    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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