Disability Services Home Page

Disability Services Staff

What is a Disability?

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Rights and Responsibilities of Students with Disabilities

A Parent's Guide to College

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MSUM Home Page

 

 

  

Minnesota State University Moorhead Disability Services Image

Service Request Form
For additional support outside of regularly scheduled services
*Note: all fields are required

Student Making Request

Phone Number

E-mail address

Service requested

Sign Language Interpreter
 Captioner

Date for Interpreter/Captioner Request

Approximate start time

Approximate end time

Location (building and room number)

Purpose of request

If you are unable to complete this form due to your disability, please contact Greg Toutges, Coordinator of Disability Services at 477-2131 and assistance will be arranged.

 

 

© 2003 Minnesota State University Moorhead
1104 7th Ave S.
Moorhead, MN 56563
1.800.593.7246
For TTY communication, contact the Minnesota Relay Service at 1-800-627-3529.
 an equal opportunity educator and employer

Contact toutges@mnstate.edu
 Last Update Date:  10/01/08