Disability Services
P.O. Box 3300 Somerville, New Jersey 08876-1265
Phone: 908-526-1200 x8921 Fax: 908-526-3494
Email: Disabilityservices2@raritanval.edu
Note-taker Request Form
INSTRUCTIONS: Students are advised to meet with each professor to determine the need for
note taking during the first week of class. Please complete and submit this form along with the
attached agreement as soon as possible, as the process of coordinating note taking support can
take up to two-three weeks. If you have any difficulty with this process, contact Disabilities
Services, College Center room c-143 or email disabilityservices2@raritanval.edu
Student Name ________________________________
Student ID# __G_________________________________
Email ________________________________
Indicate how you like to receive notes (check one):
have notes emailed to me Anonymously. I prefer to (pick one): pick up my notes
Directly. I prefer to coordinate with the note-taker
Course Title
i.e. BIOL 120
Course CRN
i.e. 12838
Course Day
Course Time
i.e. 12:00p2:00p
Instructor’s Name
First and Last
Student signature: Date:
For office use only:
Course Title
Note-taker Assigned
Note Taker Email
click to sign
click to edit
Disability Services
P.O. Box 3300 Somerville, New Jersey 08876-1265
Phone: 908-526-1200 x8921 Fax: 908-526-3494
Email: Disabilityservices2@raritanval.edu
Note-taking Services Agreement
In accepting note-taking support, I agree to the following terms and conditions:
I will pick up my accommodation letters from DS at the start of the semester and will present my
professors with my accommodation letters soon after.
It is my responsibility to request a note-taker after attending class, presenting my
accommodation letter to my professors, and determining if there is a need for note taking
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 and Agreement. I
understand that I will not receive note-takers until both forms are submitted to Disability
Services (DS).
I will notify DS immediately if I drop or add a course requiring note-taking.
I understand that it takes two-three weeks to identify note-takers and that if I add a course after
the start of the semester there will likely be a delay before a note-taker is in place.
Should I choose, I can make myself known to my note-taker and arrange to pick up notes
directly from him or her. Otherwise, I may remain anonymous and understand that notes will
be available to pick up or via email.
If I find that I no longer need notes I will let DS know immediately so that note- taking support
can be cancelled.
If a note-taker is absent, or a note-taker has not yet been identified, I may use a recording
device until the note-taker returns or is hired.
Note-takers are only available for taking in-class notes. I will not request anything additional of
my note-taker(s), such as organizing notes, or typing papers.
I will notify DS immediately if there are any problems with the quality or timing of notes taken
for me.
If applicable, I will pick up notes from DS on at least a weekly basis; I acknowledge that failure to
pick up notes for three consecutive weeks, without a reasonable and timely explanation, may
result in cancellation of note-taking support.
I agree to the above terms and conditions of the note-taking support being provided to me.
Student signature: Date:
click to sign
click to edit
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