NOTE TAKING REQUEST FORM

The Office for Disability Services (ODS)
The Pennsylvania State University
116 Boucke Building * University Park, PA 16802-5902
V/TTY: 814-863-1807 FAX: 814-863-3217

    In order to receive note taking services for a course or courses, the student must:

1. Officially register with ODS and have a documented disability that requires note taking as a reasonable academic adjustment supported by the documentation.
2. Meet with their Disability Specialist from ODS each semester that note taking is requested.ODS requires that students provide the date they met with their disability specialist or the date of a scheduled appointment with their disability specialist.
3. Have approval for note taking as an academic adjustment for the semester notes are requested.
4. Complete and submit the Note taking Request Form.
5. Follow ODS policies and procedures for obtaining note taking services.
6. Submit the Note Taking Request Form to ODS by one of the following methods:
   
   
   • Deliver the form to the ODS front desk at 116 Boucke.
   • Fax the form to ODS at 814-863-3217.   

   Student Name:		PSU ID Number (no dashes):
   Semester(e.g., Fall 2006):		PSU Email ID (xyz123):	@psu.edu

   Date Scheduled to meet with Disability Specialist this semester:

   Date met with Disability Specialist this semester:

   When initiating note taking services fill out the blocks related to the courses that note taking services are requested and place an X in the Enrolled box. Any changes that occur to a student's initial request (Drop/Withdrawal/Add a course, or Request Cancelled) a new Note Taking Request Form must be submitted to ODS.

   Mark the changes by indicating: A=Added; D=Dropped; W=Withdrew; or C= Cancel Request

   List below only those courses for which you are requesting note taking services:

   Course Name (example: Engl)	Course Number (example: 015)	Section (example 003)	Instructor Name	Instructor email	Enrolled	A/D/W/C

   
   
   

   William Welsh
   Director, Office for Disability Services
   The Pennsylvania State University
   116 Boucke Building . University Park, PA 16802
   Phone: 814 863-1807 (V/TTY) . Fax: 814 863-3217

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   For information about republication or permissions,
   please contact William Welsh
   
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   Web page last modified August 15, 2007