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Disability Resources Department


Forms

DRD Student Intake Packet (All other disabilities, not LD*)

      Download, print, fill-in and sign:

Request for Services

      
Student_Questionnaire.pdf

      
      
Authorization_for_Release_of_Information.pdf
      
Medical_Disability_Verification.pdf

           Please note:

      
  • It is the student's responsibility to obtain and provide a medical verification of disability to the SRJC Disability Resources Department.
      
  • In lieu of "Medical Disability Verification" form, you may provide medical records signed by a certifying medical professional which clearly state the diagnosis, duration and limitations of your disability.
      
  • Certifying medical professional is defined as: Medical doctor or other licensed certifying professional such as psychologist or State of California Department of Vocational Rehabilitation Counselor.

      *Have a Learning Disability (LD)? Go to Learning Disability Intake Forms.