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MSJC > Disabled Students Programs & Services > New Student - Intake Forms

New Student - Intake Forms

New DSPS Students:

Come into our office to schedule a counselling appointment.

Below are forms that need to be filled out, printed, signed and brought to our office during your intake meeting with the counselor.  If you need assistance filling out the forms or have questions, bring them with you and we would be happy to explain.


Student Rights and Responsibilities

Consent to Release


Consent to Release to Family (if applicable)

We also need a copy of your disability verification. Your accommodations will be decided based on these form(s). Below are options for providing this documentation:


  • DSPS Disability Verification Form Print this form, complete the top section, have a medical doctor fill out, and then bring with you to your intake appointment.
  • IEP (Individual Education Plan) bring a copy for us to keep in your file.
  • 504 Plan
  • Current Audiogram 
  • DD214
  • Psychological Exam/Testing 
  • Physical Exam 
  • LD Testing 
  • History from another college 
  • Eye exam from Ophthalmologist 


Please arrive at least 15 minutes early for your appointments. Intake appointments will be made for 30 minutes. You might be asked to make a follow up appointment.