Center for Student Accessibility 1P-101 * = This field is required. Today's date: Student Information Last Name * First Name * Middle Initial Student e-mail address * Course Information Course Name * Class Number Instructor Semester - None -FallWinterSpringSummer Year Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 Book Information ISBN Number * Textbook Name * Textbook Author Textbook Edition Publisher Is this the required course textbook? * Yes No Preferred alternate textbook format * - Select -MS WordPDFAudioMP3MP4Braille Receipt on file at The Center for Student Accessibility? * Yes No Confirmation Note: This accommodation is provided on a first come, first serve basis. Because this process takes time, we encourage you to plan ahead. The sooner you submit your request (with all required materials attached), the more likely you are to get your material soon enough for your class. It is important that all necessary information be filled out on this request form, along with all required documentations attached. You are approved for this accommodation based on the documentation we have on file. The Center for Student Accessibility will attempt to obtain the alternate format of the text (based on your preference) from publishers, https://www.learningally.org/ formally ( RFB&D), or from https://www.bookshare.org/. Where these are not available, CSA will begin in-house conversion which may take some time. Please be sure to inform CSA if you have dropped a course and/or will no longer need the material. An electronic file (E-text) is copyrighted and may not be reproduced or distributed in a format other than a specialized format exclusively reproduced for use by students with a documented disability that prohibits the person's use of instructional materials in standard print formats. Any reproduction or distribution in a format other than a specialized format is an infringement of the copyright law. Misuse of the specialized format will result in disciplinary action by the University Judicial Officer. Please confirm * Yes Leave this field blank
