DRC Forms

Important Forms for New Students

Applying for Services

• Application for DRC Services 
• Medical Verification Form
• Learning Disability (LD) Packet (in English)
• Learning Disability (LD) Packet (en Español)
• 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 by submitting this form:

• Request for Accommodation Memo

Test Proctoring

• Students, please complete this form:  Request Proctoring Appointments from the DRC
• Instructors, if the student will complete their exam at the DRC, please complete this form: DRC Proctor Information Form
• Instructors, if the student will complete their exam at the Learning Center, please complete this form: Cañada College Learning Center Test Proctoring Instructions

Peer Note Taker

Note: Students with note taking support accommodations may use this form to request a peer note taker. Also please complete the Assistive Technology form to request access to Otter.ai, Glean, or a smart-pen.

• Note Taking Request Form 

Alternative Media and/or Assistive Technology

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

Deaf/Hard of Hearing Accommodations

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

Other Accommodations

• Tutoring Agreement
• Remote Learning Robot Request Form
• 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 Note takers:
  • Note Taker 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