Request Peer Notes Form

If you qualify for this accommodation with Disability Services, please follow the below instructions to place a request for a peer note taker. Contact Disability Services at dsnotes@uccs.edu with questions about the Peer Notes program.

Submit your Semester Request in Accommodate for the term to send Faculty Accommodation Letters to your faculty.
Review your courses and the instructional mode to determine which classes you need to request supplemental notes.
Please fill out the form with the classes you are requesting peer notes.

Term Requested (i.e. Fall 2020, Spring 2021)

First Name:

Last Name:

UCCS Student Email:

Class Info

Class Name/Number:

Class Section:

Instructor Name:

Instructional Format

If the course is online or remote asynchronous, please explain why supplemental notes via peer note taker is needed?

Frequency (i.e. MWF, T/TR, F only):

Class time:

Class Begin Date:

Class End Date:

Add Another Class

Class Two

Class Name/Number:

Class Section:

Instructor Name:

Instructional Format

If the course is online or remote synchronous, please explain why supplemental notes via peer note taker is needed?

Frequency:

Class time:

Class Begin Date:

Class End Date:

Add Another Class

Class Three

Class Name/Number:

Class Section:

Instructor Name:

Instructional Format

If the course is online or remote synchronous, please explain why supplemental notes via peer note taker is needed?

Frequency:

Class time:

Class Begin Date:

Class End Date:

Add Another Class

Class Four

Class Name/Number:

Class Section:

Instructor Name:

Instructional Format

If the course is online or remote synchronous, please explain why supplemental notes via peer note taker is needed?

Frequency:

Class time:

Class Begin Date:

Class End Date:

Add Another Class

Class Five

Class Name/Number:

Class Section:

Instructor Name:

Instructional Format

If the course is online or remote synchronous, please explain why supplemental notes via peer note taker is needed?

Frequency:

Class time:

Class Begin Date:

Class End Date:

Add Another Class

Class Six

Class Name/Number:

Class Section:

Instructor Name:

Instructional Format

If the course is online or remote synchronous, please explain why supplemental notes via peer note taker is needed?

Frequency:

Class time:

Class Begin Date:

Class End Date:

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Class Info

Class Two

Class Three

Class Four

Class Five

Class Six