DHHS Service Cancellation

Santa Monica College
Student Support
Center for Students with Disabilities
Student Resources
DHHS Service Cancellation Request

Please complete the form below to cancel any interpreter/captionist request you've previously made.

Please don't fill out this input box.

STUDENT INFORMATION

Name: *

Email Address: *

CANCELLATION INFORMATION

Which service would you like to cancel?: *

Interpreter

Captioning

Specify the reason for canceling and include questions or comments below: *

SERVICE INFORMATION
For one-time requests, specify your date and start/end times.

Start date & start time:

End date & end time:

For weekly requests, specify your days and times. If your schedule varies by day, specify in the comment box.

Start date & weekly start time:

End date & weekly end time:

Please enter any questions or comments below: Before clicking "submit" below, please make sure all information is complete to ensure services can be provided.

I have read the Student Rights and Responsibilities and agree to follow it. I agree to the terms for canceling DHHS services:

I agree