Online forms: Disability Services Service Request Form

Please fill out your request below - must be currently registered with the Office of Disability Services

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To ensure accommodations are in place in a timely manner, COMPLETED requests are due to Disability Services no later than 3 WEEKS BEFORE the beginning of the semester. Audio Formats will not be released to the student without proof of purchase due to copyright laws.

1. Term Required Help: Spring 2019

2. Name Required

3. Butler ID Required Help: (@00000000)

4. Birth Date Required

5. Address Required

6. State Required

7. City Required

8. Zip Required

9. Phone Required

10. Butler E-mail Required

11. Classes

CRN #	Course # and Name	Instructor's Name	Alternative Text	Note Taker
CRN # 1	Course # and Name 1	Instructor's Name 1	Alternative Text 1 Yes	Note Taker 1 Yes
CRN # 2	Course # and Name 2	Instructor's Name 2	Alternative Text 2 Yes	Note Taker 2 Yes
CRN # 3	Course # and Name 3	Instructor's Name 3	Alternative Text 3 Yes	Note Taker 3 Yes
CRN # 4	Course # and Name 4	Instructor's Name 4	Alternative Text 4 Yes	Note Taker 4 Yes
CRN # 5	Course # and Name 5	Instructor's Name 5	Alternative Text 5 Yes	Note Taker 5 Yes
CRN # 6	Course # and Name 6	Instructor's Name 6	Alternative Text 6 Yes	Note Taker 6 Yes