DRC Forms
For Students REGISTERED TO THE DRC BEFORE JANUARY 20TH, 2022, please complete this form as soon as possible:
Faculty and Staff Referrals to the DRC
Intake Forms for New Students
- Application for DRC Services
- Medical Verification Form
- Learning Disability (LD) Packet
- Upload Disability Documentation - Use this form only if you could not upload it on the application.
Request Alternative Media Services (anything related to technology for school work)
Forms to Request Accommodations
- ASL Interpreter Request and Agreement
- ASL Interpreter Request for EVENTS - Please submit this request 3 weeks before the event
- Audio Recording Agreement for Students
- Audio Recording Acknowledgement for Faculty
- CART Services Request and Agreement
- CART Services Request for EVENTS - Please submit this request 3 weeks before the event
- Furniture Request Form
- Notetaking Request Form
- Notetaker Agreement - This form is for notetakers.
- Personal Care Attendant Agreement for Students
- Personal Care Attendant (PCA) Agreement - This must be completed by a PCA
- Request for Accommodation Memo - Must request every semester you'd like to use accommodations
- Reserved Seating Request
- Service Animal Agreement
Request Proctoring
- Proctor Request Form (PDF) - New Version - Please use "fill & sign" option to type information, and "draw" option to sign
Requests to Send or Receive Your 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)
DRC Counseling Internships
- These two forms are required:
DRC Student Assistants (Student Ambassadors, Specialized Tutors, Mentors, and Notetakers)
- For Noteakers ONLY:
- For Student Ambassadors, Specialized Tutors, and Mentors: