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ACCESS Intake Form

Are you a:
New to BCC
Not yet enrolled
Currently registered in classes
Formerly in the ACCESS program
Name
Disability Information

ACCESS Rights and Responsibilities

Barstow Community College District provides educational services and access for students with documented disabilities who intend to pursue coursework at Barstow Community College. A variety of programs and services are available which gives students with disabilities the opportunity to participate fully in all aspects of Barstow Community College programs and activities through appropriate and reasonable accommodations. By completing this form, I am applying for services from the Accessibility Coordination Center and Educational Support Services (ACCESS).

 

Rights:

My participation in ACCESS shall be entirely voluntary.

Receiving support services or instruction through ACCESS shall not preclude me from also participating in any other course, program or activity offered by Barstow Community College, or from receiving basic accommodations required by state and federal law.

I have been advised that a copy of ACCESS Student Handbook (policies & procedures) and the opportunity to register to vote in local, state, and national elections via “Motor Voter Registration” is available to me on the Special Programs and Services Canvas webpage.

All records maintained by ACCESS Personnel pertaining to my disability (s) shall be protected from disclosure and shall be subject to all other requirements for handling of student records.

 

Responsibilities:

I will provide ACCESS with the necessary documentation and/or forms (medical, educational, etc.) to verify my disability.

I will meet with an ACCESS Counselor to complete an Academic Accommodation Plan (AAP), and also meet with an ACCESS Counselor at least once per semester to update the Academic Accommodation Plan.

I will utilize ACCESS services in a responsible manner. I understand that ACCESS uses written service provision policies and procedures, which must be adhered to for the continuation of services.

I will comply with the Student Code of Conduct adopted by Barstow Community College.

I must demonstrate measurable progress toward the goals established in my Student Education Plan (SEP).NOTE: Authorities cited: Title 5 C.C.R. Section 56000 m., Education Code Sections 66701, 67310-37612,70901, and 84850.


I understand and agree to the above Student Rights and Responsibilities, and I will abide by them. I give permission for ACCESS staff to discuss my educational situation with other professionals who have a legitimate educational need to know.

Voter Registration Information

Under the National Voter Registration Act (NVRA) of 1992,  DSPS is an Agency-Based Registration Site, where students are offered information, voter registration application forms and the opportunity to become registered voters. 

There is no obligation to register to vote and the student's decision will have no effect on services offered by DSPS. 

Voter registration information and online application forms are also available at the website for the Secretary of State of California

Want More Information on Registering to Vote?

If you are not registered to vote where you live now, would you like to apply to register to vote here today? (Check One Box)