NTC
Classes
Notetaking Request Form
Student Information: Please fill out the contact and class information below.
Semester:
Fall
Spring
Summer
Mid-Term
Last name:
First name:
Student ID:
NTC Email:
Telephone #:
Class Name:
Class Number:
Instructor's Name:
Complete the section below for note taking request instance one.
Instance #1:
Date:
Time:
Room:
Complete the section below for note taking request instance two.
Instance #2
Date:
Time:
Room:
Complete the section below for note taking request instance three.
Instance #3
Date:
Time:
Room:
Notetaking Authorization/Agreement for Release Release of Information:
Northcentral Technical College considers information you share with us regarding your disability to be private and confidential. Please let us know if you would like to have a communication relationship with your notetaker. Check the "yes" button, if you prefer the notetaker to know who you are. Check the "no" button if you would like to remain anonymous.
Concerning Notetaking Services:
Yes, I would like my notetaker to know who I am
No, I do NOT want my notetaker to know who I am.
When you submit this form, it wil be emailed to
notetaker@ntc.edu
It may take approximately one week for you to begin receiving notes through your NTC e-mail account. If you have any questions or comments, please contact Sally Decker, Tutor /Notetaker Specialist, The learning Center, Room A, 715-6753331 ext. 4757
