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STUDENT DISABILITY RESOURCE CENTER James L. Welch Hall (WH) 180 PHONE: (310) 2433660 EMAIL: sdrc@csudh.edu FAX: (310) 9287267FORM FOR DOCUMENTING MEDICAL AND PHYSICAL DISABILITIES The outline below
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Fill out the personal information section of the form, including your name, address, and contact information.
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Provide information about your disability, such as the specific diagnosis and any supporting documentation or medical records.
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Indicate any accommodations or services that you may require, such as assistive technology, note-taking assistance, or extended time for exams.
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Include any relevant educational history, such as previous accommodations or services received, or any specific challenges or barriers you have faced in your academic journey.
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If applicable, provide contact information for any healthcare or educational professionals who can support your disability claim.
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Sign and date the form, certifying that all the information provided is true and accurate.
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Submit the completed form to the relevant educational institution or disability support services office.

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