Applications Application

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Applications Application

Introduction

Type: YCCD Application for DSPS.

Dear Student,

Thank you for your interest in receiving services through DSPS at Yuba Community College District.

Please complete the DSPS application and attach documentation verifying your specific disability. In your application, be sure to explain how your disability affects your education. This information is required to help determine your eligibility for services and to ensure we can provide appropriate and reasonable accommodations.

By submitting the application, you acknowledge that you are applying for DSPS services and will provide the necessary documentation to verify your disability.

Once your application is submitted, you will receive a confirmation email and a request to contact us to schedule an Intake appointment. Intake appointments can be completed via Zoom, phone, or in person, based on your preference. If you do not hear from us within 2–3 business days after receiving the confirmation, please contact the DSPS office to confirm we have received your disability verification.

We look forward to supporting you in achieving your educational goals!

DSPS Staff
Yuba Community College District

Application Information

Campusrequired field:

Start Termrequired field:

Personal Information

Legal First Namerequired field:

Preferred Name:

Middle Name:

Last Namerequired field:

YCCD ID numberrequired field:

Hint: (Example: 0123456) WITHOUT THE LETTER

Birth Daterequired field:

Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2025).

Pronoun:

Contact Information

YCCD Email Addressrequired field:

Primary Phone Numberrequired field:Specify country code for Primary Phone NumberSpecify Primary Phone Number

Secondary Phone Number:Specify country code for Secondary Phone NumberSpecify Secondary Phone Number

Disability Information

Primary Disabilityrequired field:

Other Disability or Note:

List of Questions

Question 1: Is your disability temporary?required field

Yes (Indicate estimated date of recovery) (Additional Comment Required)

Unsure

Additional Comment:

Question 2: How does your disability impact your participation in educational activities (e.g., in the classroom, accessing the campus, taking exams)?

(This helps us understand the types of accommodations or support that may be most helpful.)required field

Question 4: Are you currently taking any medications that may impact your education that you would like DSPS to be aware of in order to better support you?required field

Yes (please provide any details you feel comfortable sharing in the box below)

Additional Comment:

Question 5: Please describe any current challenges or situations that may be impacting your education at this time (e.g., medical, psychological, cognitive, physical, environmental, relational, or other factors you feel are relevant).

(Your response will help us better understand how to support your academic success. Feel free to share as much or as little as you are comfortable with.)required field

Question 6: In what ways are you hoping to benefit from DSPS services?

(For example, you might be seeking academic accommodations, advocacy, assistive technology, or guidance navigating your educational environment. Your response helps us understand how to best support you.)required field

Question 7: What is your current educational and/or career goal?

Question 8: Have you ever attended Special Education or remedial classes?required field

Yes

Prefer not to answer

Question 9: Do you have a history of substance use that you believe may impact your education or for which you are seeking support or accommodations?

(This question is optional. Any information you choose to share will be kept confidential and used only to help determine appropriate support.)

Yes

Prefer not to answer

Additional Comment:

Question 10: Are you currently seeing a physician, therapist, or other mental health professional related to your disability or support needs?

(This information is optional and will only be used to help us better understand and support your needs. You may share any relevant details in the box below.)

Yes

Prefer not to answer

Additional Comment:

Question 11: Are you currently participating in individual or group therapy?

(This question is optional. Sharing this information may help us better understand how to support you. All responses are kept confidential.)

If you’d like, you may share any relevant details (e.g., frequency, focus, provider type):

Yes

Additional Comment:

Question 12: Disability Verification (DV) is required to determine eligibility for DSPS services. Which type of DV will you provide:required field

IEP or 504 Plan

Disability Verification Form - Completed by a Licensed Professional

Physician's Note or Medical Record Note

I suspect I have a Learning Disability and would like to be assessed.

Other Disability Verification (Additional Comment Required)

Additional Comment:

Question 13: Voter Registration

Please click the following link to let us know whether or not you are interested in registering to vote: Click Here

Please click the box below to confirm that you've completed the Voter Preference Form. If you've indicated that you would like to register to vote, voter registration information will be emailed to you:required field

I have completed the Voter Preference Form.

Question 14: Please type your name below as your signaturerequired field

Form Submission

I must provide documentation that verifies my disability to DSPS in order to receive services and accommodation.
Your disability-related information at YCCD is confidential and will only be disclosed to those that have a legitimate educational need to know or those that you have authorized as a contact.
DSPS Staff will consult with appropriate personnel on a need-to-know basis in the event of a health or safety issue.
I have read and acknowledge the information in the DSPS Student Rights and Responsibilities, available on the college website or by request.
I may appeal and/or file a grievance following college policies and procedures.

By submitting, I acknowledge and agree to the above statements.

Questions?

Woodland Community College
2300 E. Gibson Road, Building 700, Room 764
Woodland, CA 95776
(530) 661-5797
Wccdsps@yccd.edu

Yuba College
2088 North Beale Road, Building 1800
Marysville, CA 95901
(530) 741-6795
dspsinfo@yccd.edu