Note Taker Verification Form

STUDENT ACCESSIBILITY SERVICES

Note Taker Verification Form
Instructions: This form is required to be completed for each term within the first week of class. Students and their note takers are required to review the Student and Note Taker Responsibilities Guide on our website at https://www.nu.edu/student-services/accessibility/accessibility-forms/.
Student Name:

First NameLast Name
ID #:
Note Taker Name:

First NameLast Name
ID #:
Instructor Name:

First NameLast Name
Course Name and #:
Course Section #:
Class Start Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Class End Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
STUDENT VERIFICATION
By signing below, I agree to the above named student taking notes for me for the above referenced course. I further agree to notify the Academic Accommodations Coordinator at accommodations@nu.edu if I drop this class and I understand that I am not entitled to notes taken for me for classes that I do not attend.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
NOTE TAKER VERIFICATION
By signing below, I agree to take notes for the above named student for the above referenced course. I further agree to notify the Academic Accommodations Coordinator at accommodations@nu.edu if I drop this class or am not able to carry out this duty. I agree to be present at each scheduled class; if I will not be present, I agree to notify the above named student in advance so that he or she may make alternate arrangements.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please note: If you have any questions regarding note-taking services, please contact the Academic Accommodations Coordinator at accommodations@nu.edu. The note taker will be credited $100 to their student account 10 days after the class end date if the completed form is received in the Central Business Office on that date. If you have any questions regarding payment to your student account, contact Student Business Services at (858) 642-8563.
Should be Empty:

STUDENT ACCESSIBILITY SERVICES

STUDENT VERIFICATION

NOTE TAKER VERIFICATION