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SSWD Application/Documentation Forms

To apply for SSWD support services, you may download and print out the forms from this web page. To establish your eligibility for services, you must sign and submit the Support Services Application form, the respective verification/certification forms or documentation (type of documentation depends on disability, see list in box below) completed by either licensed physicians or appropriate professionals, and a copy of unofficial transcripts. These documents may be submitted in person, by mail, or by fax (916) 278-7825.

After you complete and submit your application and the required documentation, your file will be reviewed and we will contact you to schedule an intake appointment to meet with an SSWD Counselor or Specialist or advised of additional documentation needed prior to intake. You may be requested to provide additional medical documentation if the information provided does not adequately address your functional limitations in an academic setting or what, if any, accommodation is recommended.  Both SSWD and the student requesting an accommodation must engage in an interactive process. As part of this process, SSWD may need to consult with other individuals within or outside of Sacramento State for the purpose of evaluating an application for student support services and/or requested reasonable accommodation.

See SSWD Contact Process below for additional information about the process.  Please contact the office if you have any questions regarding the forms or need to request them in an alternate format. The SSWD office numbers are (916) 278-6955 (Voice) or (916) 278-7239 (TDD).

FORMS:

MOBILITY OR OTHER PHYSICAL DISABILITIES

  • Support Services Application (.doc) (To be completed by Student)
  • Physician Certification Form (.pdf): This form is to be completed by a licensed medical doctor who is familiar with your physical/mobility limitations, e.g. arthritis, diabetes, amputation, neurological disorders, spinal cord injury, cardiovascular disease, cancer, MD, MS, etc. If you would like alternative documentation to be reviewed and considered, please submit it with your application. You may be requested to provide additional medical documentation if the information provided does not adequately address your functional limitations in an academic setting.
  • Copy of current/previous unofficial college transcripts. If you are transferring from a high school, please submit high school transcripts.
  • Cart Services Form (.doc): Students with mobility impairments may be eligible for the limited on-campus transportation between classes. Please contact the office if you have questions regarding this service.
  • Parking Fee Waiver Form  - Students must have a current, valid DMV issued Disabled Person Placard or License Plate in order to apply for this waiver. Students will need to supply a copy of the registration/identification card for their DMV Disabled Person Placard or License Plate with this form. Waiver forms are reviewed by Financial Aid for income eligibility requirements. Please allow 5-7 working days for your request to be processed. 

 LEGALLY BLIND/VISUAL IMPAIRMENT

  • Support Services Application (.doc) (To be completed by Student)
  • Ophthalmological Certification Form (.doc): This form needs to be filled out by an ophthalmologist if your visual acuity and/or peripheral vision has been impaired by a congenital birth disorder, medical condition, or injury to the eye. If you would like alternative documentation to be reviewed and considered, please submit it with your application. You may be requested to provide additional medical documentation if the information provided does not adequately address your functional limitations in an academic setting.
  • Copy of current/previous unofficial college transcripts. If you are transferring from a high school, please submit high school transcripts.

 DEAF/HARD OF HEARING

  • Support Services Application (.doc) (To be completed by Student)
  • SSWD does not have a form for Deaf/Hard of Hearing disability documentation. We request that students who are deaf or hard of hearing submit their most recent audiogram and report verifying the extent and type of the hearing loss. If you would like alternative documentation to be reviewed and considered, please submit it with your application. You may be requested to provide additional medical documentation if the information provided does not adequately address your functional limitations in an academic setting.
  • Copy of current/previous unofficial college transcripts. If you are transferring from a high school, please submit high school transcripts.

 PSYCHOLOGICAL DISORDERS/COGNITIVE DISABILITIES

  • Support Services Application (.doc) (To be completed by Student)
  • Confidential Disability Documentation for Psychological Disorders including ADD/ADHD and Cognitive/Intellectual Disabilities (.pdf): This form is to be filled out by a licensed Psychiatrist, Clinical Psychologist, Neuro-psychologist or relevantly trained medical practitioner. If you would like alternative documentation to be reviewed and considered, please submit it with your application. You may be requested to provide additional medical documentation if the information provided does not adequately address your functional limitations in an academic setting.
  • Copy of current/previous unofficial college transcripts. If you are transferring from a high school, please submit high school transcripts.

 ADD/ADHD

 LEARNING DISABILITIES (for students with prior LD diagnosis)

  • Support Services Application (.doc) (To be completed by Student)
  • Learning Disabilities Intake Form (.pdf): To be completed by student. This includes a self-timed writing sample which must be handwritten.
  • SSWD encourages students to submit all available documentation for review. Prior assessments, IEP/504 plans, records of prior accommodations, documentation of any other disabilities, etc. and an interactive discussion with the student are all considered when evaluating requests for accommodations.  If, after review and discussion, the documentation is inadequate to establish current eligibility for accommodations, a Learning Disability Specialist will discuss recommendations with the student. 
  • Copy of current/previous unofficial college transcripts. If you are transferring from a high school, please submit high school transcripts.

 SSWD CONTACT PROCESS

  1. PRELIMINARY CONTACT
    1. Complete Support Services Application Form (.doc).
    2. Have Verification/Certification form (see list above) and/or LD diagnostic records (including test scores) or alternative documentation sent or brought in to Services to Students with Disabilities. Please note that supplemental testing and/or documentation may be requested.
    3. Have transcripts (can be a copy of the official transcripts or unofficial transcripts) sent or brought in.
    4. SSWD will review the submitted application and documentation within two weeks of receipt. The student will be contacted for an intake appointment with a Disability Management Counselor/LD Specialist or advised of additional documentation needed prior to intake.
  2. INTAKE INTERVIEW WITH COUNSELOR/SPECIALIST (ABOUT 1 HOUR)
    1. Review the documentation/diagnostic records and transcripts.
    2. Perform a needs assessment to determine functional limitations in an academic setting.
    3. Determine eligibility for support services.
    4. Complete advisement plan and paperwork.
    5. Set up support services.
  3. DISABILITY-RELATED ADVISING APPOINTMENTS
    Students are encouraged to meet regularly with their Counselor/Specialist. Students can also schedule advising appointments throughout the semester by calling SSWD at (916) 278-6955 (Voice), or (916) 278-7239 (TDD).

Concerns regarding eligibility and the process or provision of accommodations should be discussed initially with the SSWD Counselor/Specialist. If unresolved, the student can meet with the Director of SSWD. Students who wish to appeal above the Director level can be referred to campus administrative staff who oversee the specific area of concern (refer to the Academic Program Access for Students with Disabilities policy).

To view PDF or Word documents:

Please inform SSWD at sswd@csus.edu if you encounter any problems accessing the SSWD web site.