Learning Disability Testing Interest Form

Learning Disability Testing Interest Form

If you are experiencing difficulties in meeting the academic demands of the regular vocational and/or academic classes at Chaffey College, you may request a learning disabilities assessment to determine the source of your problems. We welcome you, whether you decided to come in on your own or you were referred by someone else within or outside of Chaffey College.

Student will need to fill out this form.

You will be contacted regarding testing within 15 instructional days

Getting tested for a learning disability does not guarantee that eligibility will be determined for services.

Students need to be enrolled in courses to qualify for LD testing.

Students who have questions should contact the DPS office at DPS.staff@chaffey.edu or call 909-652-6379 during business hours.

Student Name *

First Name

Last Name

Student-Chaffey ID number *

Example-085000

Phone*

Please include Area Code

Email*

Chaffey Email Preferred-If unavailable personal email if fine

Why are you interested in getting tested for a Learning Disability?*

Who referred you?/How did you hear about Learning disability testing?*

Example: Instructor, DPS office, DPS Website, Counselor etc.

What kind of academic challenges are you experiencing?*

Reading Writing Math Memory

Other:

Please Explain about your academic challenges *

Please elaborate on the challenges you are having with any of the areas listed above: e.g reading, math etc.