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SOUTHWESTERN COLLEGE DISABILITY SUPPORT SERVICES (Southwestern College)

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SOUTHWESTERN COLLEGE
DISABILITY SUPPORT SERVICES
American Sign Language / Real Time Captioning (RTC) Request Form
Name:
format: Last, First, M SWC ID Date
Complete all items for each request to avoid scheduling delays. Incomplete information will not be accepted.
Example Class 1
Class Name/Section BIOL 120 07 Class Name/Section
Class Days M W F Class Days
Class Start Date 02/01/21 Class Start Date
Class End Date 05/28/21 Class End Date
Class Start Time 9:00 AM Class Start Time
Class End Time 10:15 AM Class End Time
Room Number
Room Number 28-112
Request Type ASL (American Sign Lang.) RTC (Real Time Captions)
Request Type ASL RTC
Class 2 Class 3
Class Name/Section Class Name/Section
Class Days Class Days
Class Start Date Class Start Date
Class End Date Class End Date
Class Start Time Class Start Time
Class End Time Class End Time
Room Number Room Number
Request Type ASL RTC Request Type ASL RTC
Class 4 Class 5
Class Name/Section Class Name/Section
Class Days Class Days
Class Start Date Class Start Date
Class End Date Class End Date
Class Start Time Class Start Time
Class End Time Class End Time
Room Number Room Number
Request Type ASL RTC Request Type ASL RTC
One time on campus event or appointment service request:
Event or Purpose of Request:
Date Start Time
Location/Room #
End Time
Request Type: ASL RTC
STUDENT SIGNATURE: _______________________________________________________________________
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SOUTHWESTERN COLLEGE DISABILITY SUPPORT SERVICES (Southwestern College)

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Completed 2 February 2021

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