EAC Application for Services

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NewContinuingTemporary
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Student Rights and Responsibilities
Participation in the Educational Assistance Center is entirely voluntary and you are not required to apply unless you are seeking services. Section 504 of the Rehabilitation Act of 1973 and the American’s with Disabilities Act of 1990 guarantee to every individual with a disability equal access to all educational programs and activities of the college. These provisions include the services, special instruction and accommodations made to neutralize the effects of the disabilities, recognizing that there may not necessarily be equal results for all. The Board of Governors of the California Community Colleges believes that your education is important and that the services and accommodations are to be taken seriously. Your rights and responsibilities are defined by them in law, as well. Title V of the California Code of Regulations is quoted below. Student Rights 56008 a.Participation by students with disabilities in Educational Assistance Center (EAC) shall be entirely voluntary. b.Receiving support services or instruction authorized under this subchapter shall not preclude a student from also participating in any other course, program or activity offered by the college. c.All records maintained by EAC personnel pertaining to students with disabilities shall be protected from disclosure and shall be subject to all other requirements for handling of student records as provided in Subchapter 2 of Chapter 5 of this Division. Student Responsibilities 56010 a.Students receiving support services or instruction under this subchapter shall: 1.Comply with the student code of conduct adopted by the college and all other applicable statutes and regulations related to student conduct; 2.Be responsible in their use of EAC services and adhere to written services provision policies adopted by EAC; and 3.Make measurable progress toward the goals established in the student’s Student Educational Contract or, when the student is enrolled in a regular college course, meet academic standards established by the college pursuant to Subchapter 8 of Chapter 6 of this Division. b.A district may adopt a written policy providing for the suspension or termination of EAC services where a student fails to comply with subdivisions a2 or a3 of this section. Such policies shall provide for written notice to the student prior to the suspension or termination and shall afford the student an opportunity to appeal the decision. Each student shall be given a copy of this policy upon first applying for services from EAC.

I have read and understand my rights and responsibilities as they have been explained above.
CONSENT TO RELEASE
I, the undersigned, authorize the release to Oxnard College’s Educational Assistance Center (EAC) of my personal records by appropriate personnel, agencies, or institutions. I understand that release of informational items is contingent upon compliance with the Family Educational Rights and Privacy Act (FERPA) or other pertinent laws, regulations, or policies. I also authorize the EAC staff to use the obtained information in order to assist me in my educational attainments, and related educational/vocational planning. Finally, I give permission for appropriate EAC staff members to discuss my educational progress or the lack thereof with other professionals who may have a legitimate educational need to know.
DISCLOSURE TO PARENTS/GUARDIANS OF STUDENTS
As allowed by federal regulations (the Family Educational Rights & Privacy Act), Oxnard College EAC releases information contained in a student’s educational record to a student’s parents/guardians (both custodial and non custodial) if the student gives consent. If you wish your parent/guardian to have access to your information, please fill in the following information:

	Name of Parent(s)/Guardian(s)	Date:	Relationship:	Student’s Initials
Person 1
Person 2

THIS AUTHORIZATION SHALL REMAIN IN EFFECT UNTIL REVOKED IN WRITING BY THE UNDERSIGNED
ACADEMIC AGREEMENT
By signing below, I am agreeing to follow the college program of study (i.e., take the necessary classes) to reach the educational goals for my selected major. I understand that an EAC counselor will review my transcripts each year to determine if I am making measurable progress towards my goals. If I am placed on either academic notice (if my grade point falls below 2.0) or progress notice (if the number of units with entries of W”, “I”, or “NC”, reaches or exceeds 50% of all the units I have enrolled in), I will contact an EAC counselor to discuss issues related to my probationary status.

Further, I am agreeing that to help me progress in my educational and career goals, I am authorizing the OC EAC Faculty/Staff to disclose information about me to qualified individuals within the VCCCD College system. This waiver shall stay in effect until withdrawn by the student.
TEMPORARY ACCOMMODATIONS

If you provided new documentation, we will review it and determine if you are eligible for accommodations. Sometimes those accommodation are temporary and we want students to know our policy regarding these accommodations.
Temporary accommodations are typically approved for one semester and are usually implemented to serve students with short-term physical or psychological impairments, or for students waiting for Learning Disability Assessment results. These accommodations are not meant to be ongoing or to surpass one semester in length.

By signing below, I understand that these academic accommodations are temporary. I acknowledge that by receiving these temporary accommodations I am not automatically eligible for permanent accommodations and services through the Educational Assistance Center (EAC) not will it establish a history of being served as a student with disabilities. I understand that these accommodations are only authorized until the expiration date provided OR if I bring in proof of a chronic disability.
To complete your application, please sign below designating you agree to the terms you have read above and all information you have provided is accurate to the best of your knowledge/ability.
Signature*
Date*

MonthDayYear
Date
Thank you for completing the application! Please click the red button below to submit.
Academic Year
FOR CONTINUING TEMP. APPS:
TEMP. ACCOM. DATE OF APPROVAL:

MonthDayYear
Date
TEMP. ACCOM. DATE APPROVAL EXPIRES:

MonthDayYear
Date
TEMP. ACCOM. SIGNATURES
*TEMPORARY DISABILITY/PURPOSE OF ACCOMMODATIONS
FOR CONTINUING APPLICATIONS:
Verified Disability:
COORDINATOR'S SIGNATURE
DATE:
DISABILITY INFORMATION

ABIADD/ADHDAUTISMDHHIDLDMHMOBILITYVISUALLY IMPAIREDOTHER
SERVICES/ACCOMMODATIONS:

COUNSELINGORIENTATIONREGISTRATION ASSISTANCEALT. MEDIAAUDIO RECORDINGAGENCY REF.CALC. /MATH TABLEEQUIP. LOANINTERP. SERV.LD ASSESSMENTMOBILITY ASSISTANCENOTE TAKINGCAPTIONINGTUTORINGQTENOTES ON EXAMS
TESTING TIME:

1.5x2xOTHER
OTHER TESTING TIME:
OTHER ACCOMMODATIONS NOT LISTED:
MIS ENTERED BY:
Date

MonthDayYear
Date
Should be Empty:

Student Rights and Responsibilities

CONSENT TO RELEASE

DISCLOSURE TO PARENTS/GUARDIANS OF STUDENTS

THIS AUTHORIZATION SHALL REMAIN IN EFFECT UNTIL REVOKED IN WRITING BY THE UNDERSIGNED

ACADEMIC AGREEMENT

TEMPORARY ACCOMMODATIONS

To complete your application, please sign below designating you agree to the terms you have read above and all information you have provided is accurate to the best of your knowledge/ability.

Thank you for completing the application! Please click the red button below to submit.

FOR CONTINUING TEMP. APPS:

FOR CONTINUING APPLICATIONS: