Center for Disability Services

Request for Services

Instructions

Please submit to CDS as soon as possible. It is due within five school days of Priority Registration. Please fill out all fields and include your first and last name. We do not store your personal information outside of CDS and we will not use your information for any other purpose other than fulfilling your request.

Part One (Required)

Personal Information
Contact Information
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Contact Preferences
*Can we leave a detailed message at the phone number given above?

Part Two (Required)

Request Information
Services

If you would like CDS to send out a mid-quarter assessment to your instructors and then mail a copy to you then select this option.

Fill out the schedule below. Please follow up with CDS staff to check on the status of your note taking request throughout the quarter.

The process for requesting books in alternative format takes time, often times up to four weeks. If you need your books in alternative format, you must meet with the CDS Program Coordinator as soon as you register to discuss your specific needs. At this time you will fill out the proper request forms and will discuss procedures and timelines for making your request. Please note: Registering for classes and meeting with the Program Coordinator early helps to ensure that you will receive your materials in a timely manner.

# of paper copies # of online copies (for online classes only).
You must come to the CDS office to pick up the paper copies of the faculty letters, even if you filled out the online request for services form.
Interpreting
Interpretation Type

Room Relocation

Equipment And Furniture
Equipment

Furniture

Part 3 (Required)

Course Information
Please enter your class information. This information must be included in order for your request to be processed. Omitting any of the following information may delay the processing of your request.
Class 1

Complete the following only if you are requesting chairs, furniture or equipment in the classroom.
Class 2

Complete the following only if you are requesting chairs, furniture or equipment in the classroom.
Class 3

Complete the following only if you are requesting chairs, furniture or equipment in the classroom.
Class 4

Complete the following only if you are requesting chairs, furniture or equipment in the classroom.
Class 5

Complete the following only if you are requesting chairs, furniture or equipment in the classroom.

Please Read Carefully And Agree Before Submitting

I have completed this form to the best of my ability. I understand that I must follow up with a CDS staff member if I am requesting any of the following services:
  • Books In Alternative Format (such as large print materials, Braille, books on tape or e-text)
  • Furniture Or Equipment
  • Room Relocations
  • Interpreting
  • Note Taking
  • Faculty Letters