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Peer Note Taker Request Form

Peer Note Taker Request Form

Introduction

Students who are approved for the accommodation of a peer note taker should complete the form below in order to set up services for the semester.

Request A Peer Note Taker

Name * Required
First Last
Email * Required
What format will you need your notes in? * Required
- Word document
- PDF
- Any format (photo, screen grab, photo copy)
For how many classes will you need a peer note taker? * Required
- One class
- Two classes
- Three classes
- Four classes
- Five classes
Class # 1 Name and Number * Required

Ex) ACTG 210
Class # 1 Note Taker Options * Required
- I know someone in the class who I would like to be my note taker
- I will need the DRC's assistance in identifying a note taker for this class.
(Please choose one.)
Please provide the UIC email address of the note taker you have identified. * Required
Class # 2 Name and Number * Required

Ex) ACTG 210
Class # 2 Note Taker Options * Required
- I know someone in the class who I would like to be my note taker
- I will need the DRC's assistance in identifying a note taker for this class.
(Please choose one.)
Please provide the UIC email address of the note taker you have identified. * Required
Class # 2 Name and Number * Required

Ex) ACTG 210
Class # 2 Note Taker Options * Required
- I know someone in the class who I would like to be my note taker
- I will need the DRC's assistance in identifying a note taker for this class.
(Please choose one.)
Please provide the UIC email address of the note taker you have identified. * Required
Class # 3 Name and Number * Required

Ex) ACTG 210
Class # 3 Note Taker Options * Required
- I know someone in the class who I would like to be my note taker
- I will need the DRC's assistance in identifying a note taker for this class.
(Please choose one.)
Please provide the UIC email address of the note taker you have identified. * Required
Class # 2 Name and Number * Required

Ex) ACTG 210
Class # 2 Note Taker Options * Required
- I know someone in the class who I would like to be my note taker
- I will need the DRC's assistance in identifying a note taker for this class.
(Please choose one.)
Please provide the UIC email address of the note taker you have identified. * Required
Class # 3 Name and Number * Required

Ex) ACTG 210
Class # 3 Note Taker Options * Required
- I know someone in the class who I would like to be my note taker
- I will need the DRC's assistance in identifying a note taker for this class.
(Please choose one.)
Please provide the UIC email address of the note taker you have identified. * Required
Class # 4 Name and Number * Required

Ex) ACTG 210
Class # 4 Note Taker Options * Required
- I know someone in the class who I would like to be my note taker
- I will need the DRC's assistance in identifying a note taker for this class.
(Please choose one.)
Please provide the UIC email address of the note taker you have identified. * Required
Class # 2 Name and Number * Required

Ex) ACTG 210
Class # 2 Note Taker Options * Required
- I know someone in the class who I would like to be my note taker
- I will need the DRC's assistance in identifying a note taker for this class.
(Please choose one.)
Please provide the UIC email address of the note taker you have identified. * Required
Class # 3 Name and Number * Required

Ex) ACTG 210
Class # 3 Note Taker Options * Required
- I know someone in the class who I would like to be my note taker
- I will need the DRC's assistance in identifying a note taker for this class.
(Please choose one.)
Please provide the UIC email address of the note taker you have identified. * Required
Class # 4 Name and Number * Required

Ex) ACTG 210
Class # 4 Note Taker Options * Required
- I know someone in the class who I would like to be my note taker
- I will need the DRC's assistance in identifying a note taker for this class.
(Please choose one.)
Please provide the UIC email address of the note taker you have identified. * Required
Class # 5 Name and Number * Required

Ex) ACTG 210
Class # 5 Note Taker Options * Required
- I know someone in the class who I would like to be my note taker
- I will need the DRC's assistance in identifying a note taker for this class.
(Please choose one.)
Please provide the UIC email address of the note taker you have identified. * Required

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Contact

1200 W. Harrison St., 1070 SSB Chicago, IL 60607: Open M-F, 9-5

Phone: (312) 413-2183 (main office), (312) 413-4811 (testing)

Fax: (312) 413-7781

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