SSWD Application Process and Forms

To apply for SSWD support services, you may pick up the necessary forms at Lassen Hall 1008, download and print out the forms from this web page, or call and request them to be mailed. To establish your eligibility for services, you must sign and submit the Support Services Application Form (.doc) to SSWD office. You ALSO NEED to submit the respective verification/certification forms (type of form depends on disability(ies), see below) completed by either licensed physicians or appropriate professionals and a copy of unofficial transcripts. After you complete and submit your application and the verification form(s), your documentation will be reviewed and we will contact you to schedule an intake appointment to meet with a SSWD Counselor or Specialist. The SSWD office number is (916) 278-6955 (Voice), or (916) 278-7239 (TDD). Please call the office if you have any questions regarding the forms.

Legal Blindness or Visual Impairment (.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.

Deafness or Hearing Impairment Deaf or HOH students need to submit most recent audiogram and report verifying the extent and type of the hearing loss. Contact the office for additional information if the report is more than 2 years old.

Mobility or Other Functional Limitations (.doc) This form is to be completed by a licensed medical doctor who is familiar with your physical/mobility limitations, e.g. spinal cord injury, arthritis, amputation, etc. You may be requested to provide additional medical documentation if the information provided does not adequately address your functional limitations in an academic setting. Students with mobility impairments may be eligible for the on-campus transportation between classes, see details in the Cart Services form.

Psychological Disorders/ADD/ADHD/Cognitive Disabilities (.pdf) This form is to be filled out by a licensed Psychiatrist, Clinical Psychologist, Neuro-psychologist or relevantly trained medical practitioner.

Learning Disabilities Intake Form (.doc) Students with or without prior LD diagnosis need to fill out this form and the Support Services Application Form (.doc). Students without prior diagnosis will need to complete these forms for possible referral to Psychological Counseling Services (PCS) for testing and diagnosis (See PCS Learning Disorders Testing for further information on testing fees. Due to the volume of requests, there may be a waiting period). For students with prior LD diagnosis, a written, comprehensive psycho educational evaluation from a licensed psychologist, neurologist, or learning disabilities specialist will ALSO NEED to be submitted. See Learning Disability Practices for Assessment and Accommodation for documentation details.

SSWD Contact Process

1. PRELIMINARY CONTACT
   1. Complete Support Services Application Form (.doc).
      
   2. Have medical documentation and/or LD diagnostic records (including test scores) sent or brought in to Services to Students with Disabilities. Please note that supplemental testing and/or documentation may be required and requested.
      
   3. Have transcripts (can be a copy of the official transcripts or unofficial transcripts) sent or brought in.
      
   4. Complete appropriate Verification/Certification Form (see list above, e.g. Learning Disabilities Intake Form)
      
   5. 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).

Portable Document Format (.pdf) files require Adobe Reader.

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