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DSPS Online Student Application

Two easy steps to register
Welcome to the Disability Support Programs and Services (DSPS) at Mission College, Santa Clara, CA. DSPS offers services and support classes to students with disabilities to ensure equal access to programs, services and facilities. Please follow the procedures outlined below to apply.

DSPS Program Overview
DSPS provides educational services and access for eligible students with documented disabilities who intend to pursue coursework at Mission College. A variety of programs and services are available which afford eligible students with disabilities the opportunity to participate fully in all aspects of college programs and activities through appropriate and reasonable accommodations. Completion of this form constitutes an agreement to apply for DSPS.
Personal Information
  1. Note: Select when you would like to start your services.
  6. Hint: G0 followed by 7 digits
  7. Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Contact Information
  1. Hint: Enter 10-digit number only.
  2. Hint: Enter 10-digit number only.
Local Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  1. Ethnicity(ies)

Questions

  1.  
    I authorize Mission College to share my onboarding status with my high school transition staff. This authorization is voluntary and may be revoked at any time. * (Selection is Required)
Student Agreement - Application for DSPS Services

Student Responsibilities

  • I will provide the DSPS with the information, documentation and/or forms (medical, educational, etc.) deemed necessary by DSPS to verify my disability(ies).
  • I will meet with a DSPS Counselor/Advisor or Director to complete an Accommodations Plan, and agree to meet with the professional at least annually to update the Accommodations Plan.
  • I will utilize the DSPS in a responsible manner. I understand that the DSPS uses written service provision policies and procedures that must be adhered to for continuation of services.
  • I will comply with the Student Code of Conduct adopted by the college, which can also be found in the Mission College Catalog.
  • I understand that I must fulfill the requirements for participation in the DSPS Program. When I meet with the DSPS Counselor/Advisor or Director I will receive a copy of the policy on suspension of DSPS services, and I will be responsible for understanding the consequences of failing to comply with the rules for responsible use of DSPS services.
  • I understand that I will be notified in writing before any action is taken to suspend services.
  • By submitting this application, I affirm that I understand and agree with the DSPS Program responsibilities of students and I will abide by them.

The Community College District uses the information requested on this form for the purpose of determining a student's eligibility to receive authorized special services provided by the DSPS Program. Personal information recorded on this form will be kept confidential in order to protect against unauthorized disclosure. Portions of this information may be shared with the Chancellor's Office of the California Community Colleges or other state or federal agencies; however, disclosure to these parties is made in strict accordance with applicable statutes regarding confidentiality, including the Family Educational Rights and Privacy Act (20 U.S.C. 1232 (g)). Pursuant to Section 7 of the Federal Privacy Act (Public Law 93-579; 5 U.S.C. § 552a, note), providing your social security number is voluntary. The information on this form is being collected pursuant to California Education Code Sections 67310-67312, and 84850; and California Code of Regulations, Title 5, Section 56000 et seq.
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