SSD Intake Form

Certification and Authorization Student Rights and Responsibilities: I understand I have the following rights: My accommodations request and participation in the accommodation approval process are entirely voluntary. I have equal access to any and all courses, programs, jobs, services, activities, and facilities offered by UC San Diego Division of Extended Studies. UC San Diego will keep my information confidential per UC Policy and Procedures Manual Section 160-2. I understand it is my responsibility to: Provide the Disability Coordinator with accurate information, required documentation and/or forms (medical, educational, etc.) to verify my disability and support my request for services. Comply with published procedures for obtaining accommodations, academic adjustments and/or auxiliary aids and services. Comply with the UCSD Student Code of Conduct at all times. Meet the academic and non-academic standards for admission to, participation in, and/or fulfillment of essential requirements of Division of Extended Studies programs or activities. I understand that I may not be approved for certain accommodations if the accommodation would fundamentally alter or modify the nature of the class, lab or academic environment. By submitting this online form, I certify that all information is accurate to the best of my knowledge. I agree that I have read and understood all information above.