Counseling Appointment Request form 2024

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Some content may be updated based on selection

DSS Counseling Appointment Request Form

Disability Support Services
SSC-248 (2nd floor) - campus map
Phone: 925-969-2185
321 Golf Road, Pleasant Hill, CA 94523

Select Term:

Term

Student Information

First Name

Last Name

Date

DVC I.D. #

InSite Email

Phone Number

Appropriate for an appointment
(updating or creating an education plan, maximum timeframe, probation/dismissal)
Appropriate for a drop in
(urgent accommodation issue or question, upcoming semester course schedule, new DSS student intake, quick check in).

NOTE: Students must be registered with DSS to make an appointment. New students can apply for services during a drop in
appointment. All DSS students may schedule a one-hour DSS counseling appointment limited to one appointment per semester.
A 1 hour appointment is best used for updating or creating an education plan, maximum timeframe, or probation/dismissal.

DSS Drop in appointments
We offer brief counseling questions through drop in appointments, which allow 15 minutes per student. To request the zoom link for
drop in counseling, please email Rose Desmond at rdesmond@dvc.edu. No need to complete following question’s.

Are you a DSS student

Appointment Preference

Days and Times Avaliable
DSS Counseling appointments are only available
Mondays-Thursday 9 am- 5pm

Preferred DSS Counselor

Have you attended another colleges or universities other than DVC?

If you have attended another college or university, are your transcripts on file at DVC?

What is your major?

What is the reason for scheduling this appointment?

Questions? Contact Rose Desmond at rdesmond@dvc.edu

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