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This form is for students who are registered with Disability Services and have completed the intake process. This form must be completed each semester you are requesting services.

Today's Date: Semester:
You may also print out and submit a PDF version of this form to our office.
Student Name: ID#:
Phone #: Email:
 
Please list your classes and place an X in the box indicating the services needed for each class.
Course title Meeting days and time Professor Note- taker Tape recorder Extraatime on exams Digital Books Other
(type in resonse)
Example: Sociology 100 section 1 MW 10-11 Cohn         I need my syllabus enlarged

Please note for student requesting digital books, please also email me the complete book title, author, copyright date and publisher.