Request for DSPS Records

Disabled Student Programs and Services (DSPS)

Request for DSPS Records

Please note: Documents will be sent within 5 business days.

DSPS only holds student records for 5 years.

Student Contact Information

Name*

First Name

Last Name

Other names previously used

Citrus College Student ID (if known)

Date of Birth*

Telephone*

Email Address*

I, the undersigned, hereby authorize DSPS to release the following documents to me via email. Request the release of all documents referencing my disability (IEP, Psych Report, Mental and/or Physical disability form, physician letters, etc.)

Have you ever been tested for a Learning Disability at Citrus College?

Yes No

If you do not have access to your Citrus College email, please upload a copy of your state ID or Driver's License for verification purposes only.

No File Chosen

File uploads may not work on some mobile devices.

Information about the Release of DSPS Student Records

Citrus College student records are maintained in accordance with the Family Educational Rights and Privacy Act (FERPA) of 1974 and the California Education Code. Written student consent is required for access and release of information defined as educational records in federal and state law as described in Citrus College Administrative procedure 5040.

Please note: DSPS does not forward any third-party documents to others.

This authorization shall remain in effect until revoked in writing by the undersigned.

Signature*

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Use your mouse or finger to draw your signature above

Date*