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Alternative Format Request Form

This form is intended only for use by students already registered with the Access Center with this approved accommodation.

Name:  Last, First
Metro E-mail:  
Student I.D.#:  
Semester Requesting Alternative Format:  
Do you have screen/document reading software on your personal computer?   

E-Text will be e-mailed to the student’s Metro e-mail account unless the file is too large or other arrangements have been approved by the Technology Specialist.

It is important to note that all print material must be purchased for conversion into alternative format. Print material already available in our archive, obtained from the publisher or RFB&D will require proof of the purchase (original receipt) before any converted material will be released to the student. (Please refer to Alternative Text Policy and Procedure Form in the forms section of our website, www.mscd.edu/~access , regarding additional information.)

1) Print Material Information
Title:  
ISBN#:  
Author:  
Publisher:  
Year:  
Edition:  

2) Print Material Information
Title:  
ISBN#:  
Author:  
Publisher:  
Year:  
Edition:  

3) Print Material Information
Title:  
ISBN#:  
Author:  
Publisher:  
Year:  
Edition:  

4) Print Material Information
Title:  
ISBN#:  
Author:  
Publisher:  
Year:  
Edition:  

5) Print Material Information
Title:  
ISBN#:  
Author:  
Publisher:  
Year:  
Edition:  

6) Print Material Information
Title:  
ISBN#:  
Author:  
Publisher:  
Year:  
Edition:  
Requests received after the semester begins must be accompanied with a course syllabus. In order to meet immediate needs of as many students as possible after the semester begins, alternative formatted material may be provided in stages based on the course syllabus and direction from the requesting student. I understand that I am responsible for returning all RFD&D materials provided to me by the end of each semester. Requests are processed in the order they are received. I agree not to reproduce or distribute any alternative text materials nor can anyone else be allowed to do so. Any further reproduction or distribution is considered copyright infringement. By submitting this form, I understand the outlined conditions and agree to these terms.