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Note Taker Request Form
*
indicates a required field
Please complete a separate form for each class you are requesting a note taker.
First Name
Required
*
Last Name
Required
*
Email
Required
*
Campus
Required
*
Athens (including HCOM)
Chillicothe
Dublin
Eastern
eCampus
Lancaster (including Pickerington Center)
Southern (including Proctorville Center)
Zanesville (including Cambridge Center)
For what semester are you making this request?
For what semester are you making this request?
Fall
For what semester are you making this request?
Spring
For what semester are you making this request?
Summer
From whom would you like to receive your notes?
Required
*
Note taker
Student Accessibility Services
Class Name/Number
Required
*
(i.e. PSY 1010)
Class Meeting Days
Required
*
(i.e. MWF)
Class Meeting Times
Required
*
Please include start and end times.
Class Instructor's Name
Required
*
Class Instructor's Email
Required
*