Please complete this intake application and submit it to the Disability Resource Center (in Building 1600, Room 1615) along with documentation of your disability prior to your scheduled appointment with a Disabled Student Program and Services (DSPS) Counselor. Some sources of documentation that are commonly used to verify a disability include, but are not limited to the following:
• Appropriate agencies such as K-12 school districts, other colleges/universities, Regional Centers, Veteran’s Affairs, social and/or governmental service agencies, and
• Certified or licensed professionals such as Medical Doctors, Clinical Psychologists, Therapists, Ophthalmologists, Audiologists, and Speech Therapists.
Do your best to be as detailed as possible when completing this application. Any additional information that you would like to add is welcome. You will review the forms and the application at your intake appointment, so you may ask questions at that time about items you did not understand. Your responses, the documentation of disability that you provide, and the intake appointment with the DSPS Counselor will be used to determine eligibility for services. Information you share with the DSPS is confidential, protected by the Family Educational Rights and Privacy Act (FERPA) of 1974, and will not be part of your academic record at Las Positas College (LPC).