SYSTEM-WIDE NOTE-TAKER REQUEST FORM Please complete this form and submit it to your campus coordinator as soon as possible after the semester begins. If you have any difficulty with this process, contact your campus coordinator and they will assist you. Class Number and Section
Class Days and Times
Instructor’s Name
Instructor’s E-mail
Class Begins
Class Ends
e.g. PSY1101S1
e.g., MWF 12-1pm
First Name, Last Name
[email protected]
e.g.,1/5/16
e.g.5/5/16
FOR OFFICE USE ONLY Note-taker
Note: Lab classes are considered separate from lecture classes. Please check one of the following: ____ 1. I will recruit my own note-takers. ____ 2. I would like the OOA to recruit note-takers for my class(es).
TO BE COMPLETED BY STUDENT: Today’s Date:_____________ Semester/Term_____________ Student Name:______________________________________
If you selected #1, please read each statement below carefully and initial. ____ I will notify the OOA as soon as I have identified my note takers.
ID Number: ___________ Program:_____________________ Telephone Number:__________________________________
____ If I am not receiving notes on a weekly basis, I understand that it is my responsibility to inform the OOA by completing the Note-taker Feedback Form (request form from OOA).
E-mail Address: _____________________________________
____ If I am dissatisfied with the quality of my notes, I will notify the OOA and request a new note-taker by completing the Note-taker Feedback Form.
Date form received:__________________________________
Indicate how you would like to receive your notes. ___ Anonymously – I prefer for the OOA to send me my notes. ___ Directly – Note-taker will deliver notes directly to me (photo copy or email)
FOR OFFICE USE ONLY: Staff Initials:________________________________________
Date services began:_________________________________ Date services ended:_________________________________ NOTES:
Signature: _________________________________________
Note: In order to request a note-taker through Alliant University, you must first have been approved by the Office of Accessibility to use this academic accommodation. For more information, please see “How to Receive Accommodations,” available on our web page (http://www. http://www.alliant.edu/consumer/disability-services/index.php) or see the campus OOA Coordinator.
1/2016
SYSTEM-WIDE NOTE-TAKING SERVICES AGREEMENT In accepting note-taking services, I agree to the following terms and conditions, please initial each.
____ 1) Note-takers are approved for one semester. I acknowledge that I am required to renew my request each semester by completing the Note-taker Request Form. I understand that I will not receive note-takers until the form is submitted to the Office of Accessibility ____ 2) I will attend classes, as scheduled. If I miss class, it is my responsibility to obtain note for the class(s) I missed. Note-takers are not to share their notes for absences not directly related to accommodations I am eligible for, as indicated in my Accommodation Letter. ____ 3) I will notify The Office of Accessibility immediately if I drop or add a class requiring notetaking. ____ 4) I understand that it take time to identify a note-taker for each class and that if I add a class after the start of the semester there will likely be a delay of up to several weeks before a note-taker is in place. ____ 5) The OOA reserves the right to assign or change a note taker in instances where two or more OOA students are registered in the same course that require note taking services. ____ 6) If I no longer need notes I will let the Office of Accessibility know immediately so that notetaking services can be cancelled. ____ 7) If a note-taker is absent, or a note-taker has not yet been identified, I may use a recording device or recording app until the note-taker returns or is hired ____ 8) Note- takers are only available for taking in-class notes. I will note request anything additional of my note-taker(s), such as organizing notes or typing papers ____ 9) I will notify the Office of Accessibility immediately if there are any problems with the quality or timing of notes taken for me. Please complete the Note-taker Feedback Form.
I agree to the above terms and conditions of the note-taking services being provided to me. Student’s Name ______________________________________ ID Number ____________ Student’s Signature____________________________________ Date ________________
