SAS Appointment and General Information Request

Appointment and General Information Request

Please respond to the questions below and someone will contact you as soon as possible (within 1-2 business days).
If you experience any difficulty with this form, please leave us a message at (760) 795-6658. Please be sure to leave your name, SURF ID, and a phone number we can use to contact you.

Thank you!

1. Your name *This question is required.

2. Your SURF ID *This question is required.

3. Your email address *This question is required.

4. Your phone number *This question is required.

5. How can we help you? Please check all that apply. *This question is required.

I am a new student to SAS and interested in applying for services.
I am a current student with SAS and would like to meet with a counselor.
I have never been diagnosed with a disability and I am interested in meeting with a counselor to learn more about Learning Disability Assessments provided by SAS.
Other, please describe your request below…

6. Briefly describe your question or request:
(examples: I am a new student to SAS and would like to schedule an Welcome Appointment; I am a continuing student with SAS and need to renew accommodations for the next semester; I am a continuing student and need to discuss my classes/accommodations/ed plan…)
*This question is required.

7. FERPA Disclaimer: In order to comply with the Family Education Rights and Privacy Act (FERPA), a two question identification authentication will be required prior to releasing student academic information over the phone, or in remote counseling environments.
I grant permission for MiraCosta SAS to release academic information during a remote counseling appointment conducted by phone, email or video (Zoom). *This question is required.

Click to acknowledge that you have read and agree with the above paragraph.