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  • Alternative Format Textbook Request

Disability Resource Center

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  • Alternative Format Textbook Request

    Text in alternate format is provided to students with print disabilities who are registered with the Disability Resource Center and have been determined eligible for this accommodation.

    Complete and submit this form in its entirety. The Disability Resource Center 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.

    Your Information

    Name:

    Mnstate.edu Email Address:  
    All official University business will be conducted via mnstate.edu email accounts. It is essential that you access, read and use your mnstate.edu account. 

    Semester/Year:   ex. Fall 2014

    Book Information

    Complete Book Title:

    Author(s):

    Textbook Publisher:

    Year Published:

    Edition Number:

    ISBN:

    Course Information

    Course Number: ex. MUS 111

    Course Title: ex. Music Theory

    Instructor's Name: First and Last

    If the Disability Resource Center 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 the Disability Resource Center, 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 the Disability Resource Center.

    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 the Disability Resource Center 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 the Disability Resource Center as soon as possible.

    If you are unable to complete this form due to your disability, please contact Greg Toutges, Director of Disability Resource Center 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.