|
Alternative Format Textbook Request
Minnesota State University Moorhead
Disability Services (DS)
Text in alternate
format is provided to students with print disabilities who are
registered with Disability Services and have been determined eligible
for this accommodation.
Complete and submit this form in its entirety
Disability Services will not process your request to obtain this text in alternate format until you have completed the entire form.
**Complete one form for each book you need.**
Name:
E-Mail Address:
Semester/Year: ex: Fall 2008
Complete Textbook Title:
Author(s):
Textbook Publisher: (Found on the inside cover)
Year Published:
Edition Number:
ISBN:
Course Number: ex: MUS 111
Course Title: ex: Music Theory
Instructor’s Name:
If Disability Services needs to record this text for me, I would prefer:
MP3 Format on CD
MP3 Format (Posted on a password-protected website)
Cassette
I agree to return the material/equipment upon completion of the semester, in all events not later than two weeks after the completion of the semester in which material/equipment is borrowed; failure to do so may result in a hold upon my record.
If I check out any Adaptive Equipment from Disability Services, I will return it within 2 weeks of the end of the semester.
I will replace any broken or damaged adaptive equipment that I checked out from Disability Services.
I certify that I have purchased and am the legal owner of the textbook I am requesting above. I understand that if I share any files/tapes received from Disability Services with other students that I may be prosecuted for copyright infringement and many lose the right to obtain texts in alternative format.
If you drop or withdraw from a class, it is your responsibility to notify Disability Services as soon as possible
I have read the above and agree to follow the policies.
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.
|