DRC Forms

The downloadable forms on this page have been provided for your convenience. You may complete and submit from within your web browser or print the form to turn in.

General Services Form
Student Intake Form
Referral Questionnaire
Documentation Standards Learning Disability
Documentation Standards ADHD
Documentation Standards Mental Health Conditions
Medical Verification Form
Authorization to Release Confidential Information
Alternate Media Request and Agreement
Alternate Media Request and Agreement PDF
TESTING: Test Request Form
TESTING-Faculty Notification Request
TESTING: Professor Proctor Form

Contact Information

General	Alternate Media Services	Testing Services
Mailing address: 3801 W. Temple Ave. 9-103 Pomona, CA 91768	Mailing address: 3801 W. Temple Ave. 9-103 / Attn: Alt Media Pomona, CA 91768	Mailing address: 3801 W. Temple Ave. 9-103 / Attn: Testing Pomona, CA 91768
Fax: (909) 869-3271	Fax: (909) 869-3271	Fax: (909) 869-3271
Email: drc@csupomona.edu	Email: drcaltmedia@csupomona.edu	Email: drc@csupomona.edu