NOTE TAKING REQUEST FORM
Today’s Date:
Student Name:
Cell Phone:
Student Email:
Quarter:
Fall
Winter
Spring
Summer
Please fill out completely so that I get the note taker for the correct class. If you drop or add a class please let
me so that if a note taker is not needed we can make adjustments accordingly.
I will require note taking assistance in the following classes:
Course Name/Number/Section
Professor
Office Use
Please drop off this form to Penny Sens, Academic Support Center Administrative Assistant, in Room #14, 2nd
floor of Library. You will be contacted as soon as a note taker is found for your class. If you have any problems
at any time or not getting your notes please let me know.