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Activity Provider Request
To request accommodations for SLCC events please complete the form.
*
indicates a required field
Activity Provider Request
Student ID
Requestor's First Name
Required
*
Requestor's Last Name
Required
*
Email
Required
*
Phone
(###) ###-####
Type of Service
Required
*
Note: Transcriber is a real-time captioner using CART/Typewell.
Note Taker
Interpreter
Transcriber
Video Caption
Name of individual/individuals receiving service
Activity Type
Advising Appointment
Campus Event
Conference
Presentation
Activity Name
Required
*
Activity Date
Required
*
January
February
March
April
May
June
July
August
September
October
November
December
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
Activity Start Time
Required
*
01
02
03
04
05
06
07
08
09
10
11
12
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
am
pm
Activity End Time
Required
*
01
02
03
04
05
06
07
08
09
10
11
12
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
am
pm
Activity Location
Required
*
Department Index Code/cost code
Additional information
Video Title
Required
*
File Type
Required
*
File Type
URL
File Type
Other
URL
Required
*
Other
Required
*