I Am Interested in Becoming a Notetaker for a Student in My ______Class

Note-taker Contract Disability Resource Center http://www.bellevuecollege.edu/drc [email protected] Main Campus, B132 Phone: 425-564-2498 Fax: 425-564-4138 TTY: 425-564-4110 Skype for ASL: DRCatBC

Note-taker Information Today’s Date: ______I am interested in being a note taker for a student in my: Class Name: ______Item Number: ______Quarter: ______Year: ______I commit to attending class and taking clearly written or typed notes, and delivering the notes to the student or the DRC office in a timely manner as outlined in the Note-taker Guidelines (every two days for a class meeting daily or twice a week for a class meeting two or three times a week). ____ Initial Due to the nature of this position I may be involved in conversations or observe information of a confidential nature, including who may receive DRC services due to their presence in the DRC office. I understand this is confidential and will not share this information. ____ Initial As a note-taker, I understand I will be compensated in one of the following three options: Volunteer My Time: you will receive a certificate confirming 55 hours of community service after the end of the quarter Priority Registration for next quarter’s classes: the DRC will send you an email letting you know how to use this option a week before Priority Registration begins $50 Stipend: you with receive your check after the end of the quarter

I understand that if I breach any portion of this contract or the Note-taker Guidelines, DRC may terminate this contract. ____ Initial Name: ______Phone: ______Student ID: ______Address: ______Street City State Zip Code BC Email: ______Other Email: ______Signature: ______

(Instructor information on backside) Instructor Information I confirm that the student/note-taker noted above has approval to take notes in my class: Class Name: ______Item Number: ______Name: ______Signature: ______