For which quarter is this?

• Summer
• Fall
• Winter
• Spring

In which classes would you like to receive a volunteer’s copy of the class notes?

• Class #1:
• Class #2:
• Class #3:
• Class #4: 
• Class #5: 
• Class #6: 

Please give us your contact information:

Name:  *

E-mail address (from):  *

Type again to confirm e-mail (cc): *

Student I.D. Number

Phone number: 

You must pick up your notes once per week. That is your obligation in order continue to receive this service.

Please check the box to indicate that you accept and understand the following:

• If your request for note takers is late, you could miss the notes from the beginning of the quarter.  That’s why…
• …this form needs to be submitted immediately after you register for class, before the start of each quarter.
• If you add, drop, or change a class, tell Special Services.
• If you no longer need the notes, tell Special Services so we can notify the volunteer.

Is there anything else you would like to mention?

* Required