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.
Please complete one form for each book you need.
Semester/Year: ex. Fall 2014
Complete Book Title:
Course Number: ex. MUS 111
Course Title: ex. Music Theory
Instructor's Name: First and Last
If Disability Services needs to record this text for me, I would prefer:
I agree to return the material/equipment upon completion of the semester, in all events no 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 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 understand that before my request will be processed I must provide the Disability Services office with a copy of the receipts for these books to fulfill copyright obligations.
If you are unable to complete this form due to your disability, please contact Greg Toutges, Director of Disability Services at 218.477.4318 and assistance will be arranged.
Please allow time for your submission to process after you click "Submit Form". This will prevent multiple submission from being made.