Mesa Community College

Disability Resources & Services

CART Services Request

Please complete all information and click once to submit:

Date:
Student Information
Student's Name
Student's Email
Student's Contact #
Assignment Information
One Time Assignment? YES   NO
Purpose of Request: TUTORING?   YES   NO
  MEETING?   YES   NO
  OTHER:  
Service Information
Start Time:   AM   PM
End Time:   AM   PM
Day of Week
Month / Day / Year
Location
   

The student agrees to the following guidelines:

  1. I will submit a CART REQUEST FORM for each time that I need to have an captionist for special assignments. This is other than my regular captionist scheduled in my regular classes.
  2. Each CART REQUEST FORM that I submit shall be completed, signed, and dated.
  3. Each form shall be completed and submitted to the DRS office a minimum of four (4) working days, excluding weekends, PRIOR to the day the captionist is needed.
  4. In the event of a change in the test date or time, I accept responsibility for notifying the DRS office of the change by altering and initialing this form within a minimum of two (2) working days prior to the event/test date.

By submitting this form, I acknowledge that I have read and understood the guidelines. I understand any changes to the CART request must be notified to the DRS office as indicated within the guidelines. I understand that the lack of information provided in this form may result no action until all information is filled out.

Contact Disability Resources & Services by email | S & D: 480-461-7447 | RM: 480-654-7770 | fax: 480-461-7907