Serving Students with Disabilities

Changing/Cancelling Support Services

*Be sure to notify your CA of these changes/cancellations

On-line submissions are not secure. It is extremely unlikely this form would be intercepted, but if utmost confidentiality is a concern, please 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: 

CANCEL/CHANGE:   One Time    Permanent

Name of class:
Time of class:
Cancel date:

SERVICES AFFECTED:

    Interpreter - need for    minutes
    Captioner - need for    minutes
    Communication Assistant (CA)

CHANGE:   Room    Time

Date change begins:
Location: Old:       New:  
Day & Time: Old:       New:  

     

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