DRC Forms

Important Forms for New Students

Applying for Services

• Application for DRC Services 
• Medical Verification Form 
• Learning Disability (LD) Packet
• Upload Disability Documentation - Use this form if you could not upload it on the application or you need to submit updated proof of disability.

Sending/Receiving Private Disability Information 

• Permission to Release Documents and/or Information to a Third Party (ex. parent, guardian, another college, etc.)
• Permission to Request and Receive Documents from Another College or University on Your Behalf 
• Revoke Authorization to Release Information to a Third Party 
• Permission to Disclose DRC Affiliation with Another Cañada College Program (ex: TRIO, Promise, EOPS, etc)

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Student Accommodations

Important! Every semester, students must request their accommodation memo using this link:

• Request for Accommodation Memo - Must request every semester you'd like to use accommodations

Test Proctoring Forms

• Students, please complete this form:  Request Proctoring Appointments from the DRC
• Professors, please complete this form: Proctor Information Form

Notetaking Requests

Note: Students with notetaking support accommodations may use this form to request a peer notetaker. Also please complete the Assistive Technology form to request access to Otter.ai or a Smartpen.

• Notetaking Request Form 

Alternative Media and/or Assistive Technology

• Alternate Media request form - digital textbooks uploaded to Kurzweil, materials in Braille or large print, and so on
• Assistive Technology request form - software and equipment that supports learning accommodations
• Audio Recording Agreement for Students 

Accommodation Forms for Deaf/Hard of Hearing

• ASL Interpreter Request and Agreement 
• CART Services Request and Agreement

Other Accommodations

• Remote Learning Robot Request Form
• Permission for Tutoring Group Sessions
• Furniture Request Form
• Personal Care Attendant Agreement for Students
• Personal Care Attendant (PCA) Agreement - This must be completed by a PCA
• Reserved Seating Request
• Service Animal Agreement 

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For Faculty and Staff

Instructor and Staff Referrals

• Refer Students to the DRC 

DRC Student Workers

• For Peer Notetakers:
  • Notetaker Agreement
• For Student Ambassadors, Specialized Tutors, and Mentors:
  • DRC Student Assistant Application
  • Confidentiality Agreement

DRC Counseling Internships

• Both of these forms are required:
  • DRC Counseling Internship Application
  • Confidentiality Agreement