SHAWNEE STATE UNIVERSITY ::

Request to be a Note Taker

Student I.D. Number: Name:

First Middle Last

Phone Number:

(By inserting your phone number you are giving permission for its release to the student that needs a note taker)

Email Address: (Required)

Address: City: State: ZIP:

Were you a note taker or tutor for the Student Success Center last semester ?:

Are you currently working another job on campus ?:

Course Code Section# Instructor Name

I verify that I have read and understand the note taker policies. I also agree to give permission to release my phone number and e-mail address to the student that will be receiving notes.

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