UAC

1520 WSC -- 422-7673

Current Semester: Fall Winter Spring Summer Referred to UAC by:

Your First Name*: Your Last Name*:

Phone Number*: Best Time to Call: Morning Afternoon Evening

E-Mail Address*: Current Address:

City: State: Zip:

Major: Minor:

Year in School: Freshman Sophomore Junior Senior Graduate Other

Have you trained as a UAC volunteer within the past 12 months? Yes No

Areas with a * are required to complete application

Mark the appropriate boxes to indicate when you ARE available to volunteer.

(Hold CTRL to click on multiple times)

List any special skills, interests, subject areas, language(s), etc.:

PLEASE CHECK ALL THE SERVICES BELOW THAT YOU ARE INTERESTED IN. We will call and ask you to volunteer when a student requests a service you wnat to provide. We will do our best to give you a chance to work in one or more of the following areas:

Classroom Note Taking -- Take class notes for students for students with physical and learning disabilities. Each note taker volunteers for one class during the semester / term.

Volunteer Reading Program (VPR) -- Read text onto tape for students with visual and learning disabilities. Hours are flexible.

Live Reading -- Read in person to students with visual and learning disabilities. This service is offered upon the request of the student.

Reading / Scribing Tests -- Assist students with physical and learning disabilities by reading tests or writing as they dictate answers.

Typing -- Type upon request for students with physical and learning disabilities.

Campus Travel -- Help students with mobility impairments around campus, carrying book etc.

I give my permission for Service for Student with Disabilities (UAC) to release my name and phone number to students who use the services I will be providing.