Student Disability Center

Serving Students with Disabilities
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One Time Request of Support Services

On-line submissions are not secure. It is extremely unlikely this form would be intercepted, but if utmost confidentiality is a concern, please return to the forms page and use the PDF or MS Word template version which can be submitted in person, by mail, or by fax. See the Contact Us page for address and phone numbers.

Important! You should see an acknowledgment of your submission. Examine it carefully for errors. If you find any, or do not see an acknowledgment, contact the SDC at (530) 752-3184 (voice) or (530) 752-6833 (TTY).

Student Name: 

Request For:     Captioner       Interpreter      Communication Assistant

Date Needed:
Start Time:
End Time:
Location:

REASON FOR REQUEST:

Check if this request is for one of your classes.

If Yes, please explain:
If No, name of sponsoring department/unit:

If you have any questions, please contact Caryn Stromberg, Disability Specialist for Deaf & Hard of Hearing Students at 752-3184 (voice) or 752-6833 (TTY).

     

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Last updated September 19, 2003
For comments on the design or maintenance of these web pages, please send an email to the SDC.