Title of FormAdditional InformationLink to Form
Request for records or release of confidential information

Forms used to request copies of disability records or to authorize DASS to exchange information with a third party.

Email form to accommodations@csuci.edu 

Request for Documents and Release of Information Forms
Disability Verification FormForm used to document disabilities, limitations and provide supporting evidence for requested accommodations. This form must be completed and signed by a licensed/certified professional qualified to diagnose and treat the condition.Disability Verification Form (PDF, 598KB)
Self-Report FormForm used to self-report disability and how the disability impacts your learning experience.Self-Report Form (PDF, 681KB)
Stipend Note Taker Invoice Form Form required to be completed by Stipend Note Takers for payment eligibility.

Note Taker Invoice Form (PDF, 80.9KB)

 

Hourly Note Taker Invoice FormForm required to be completed by Hourly Note Takers for payment eligibility.

Hourly Note Taker Invoice (PDF, 259k)

Note Taker W204 FormForm required to be completed by Note Takers for payment eligibility.Note Taker W204 Form (PDF, 776KB)
Note Taker Direct Deposit FormOptional form used to set-up direct deposit of stipend payments for Note Takers.

Note Taker Direct Deposit Form (PDF, 134KB)

Note Taking Express App How-to GuideGuide on how to use NTE App for uploading recordings.

Note Taking Express Guide (PDF, 444K)

Request for Waiver of Campus Parking FeesCampus parking fee waiver for students with disabilities who meet the eligibility standards based on the form.

Request for Waiver of Campus Parking Fees (PDF, 318KB)

Single Room AddendumTo be completed when a student requests an accommodation of a single room in housing.

Single Room Addendum (PDF, 492KB)

Support Animal AddendumTo be completed when a student requests an accommodation for an emotional support animal in housing.

Support Animal Addendum (PDF, 520KB)

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