Captioning Service Request Form

Captioning Service Request Form

For SSU Faculty/Staff to complete
SSU Faculty/Staff Contact Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Course Number
Course Location
Media Request
Is this for an accommodation request?

YesNo
Name of eligible Student requesting captioning
Chartfield Account Number
When do you plan to use this video?

FallIntersessionSpring
What is the format of your media? Please select all that apply.

DVDVHS TapeMP4MP3YujaYouTubeOther
If Other, what format?
Course Delivery: If your course is being delivered over the Internet, please specify which platform is being used. YouTube videos with automatic captions are not accessible. We cannot caption streaming service videos (e.g. Amazon, Netflix, Hulu,) or sites that require a login.

YouTube (personal account)YouTube (CSUSonoma)CanvasZoomYujaOther
If Other, what location?
How should this media be returned

Pick Up from DSSDeliveryCampus Mail
Should be Empty:

SSU Faculty/Staff Contact Information