Interpreting and Notetaking Request Form

Name Name * First Last
Student Number *
Email *
Service Request Information

(*This form is to request service for course related appointment, group meeting, administration appointment or co-curricular activity)
Type of Service Request

Type of Service Request ASL Interpreting Real-time Caption Computerized Note-taking
Start Date Start Date * / MM / DD YYYY
End Date End Date / MM / DD YYYY
Start Time Start Time : HH MM AM/PM
End Time End Time : HH MM AM/PM
Location
Purpose of requesting this service:
If you chose OTHER, please provide details about your request:
Is this appointment related to your course?

Is this appointment related to your course? YES NO
If YES, Course Code:
Please add any additional information to assist us fulfill this request:
Disclaimer:

Support Service requests for course-related activities, such as, meetings with course directors and other university personnel should be requested with at least TWO WEEKS prior notice so that arrangements can be made. Providing Student Accessibility Services with advance notice will increase our chances for fulfilling your request.
Disclaimer Acknowledgement: *

Disclaimer Acknowledgement: I confirm that I have read the above disclaimer