Alternative Format Request Form

Office of AccessabilityAlternative Format Request Form

Keep in mind that there is no guarantee that the text you are requesting will be immediately available. It may take as long as one week to obtain the requested text in alternate format.

Alternative Format Request Agreement Form must be signed and returned to 300HN before receiving the alternate texts.

Student Name Student Name * First Last
Emplid *
Contact (Email) *
Contact (Phone) Contact (Phone) - ### - ### ####
Course Title/Number *
Instructor's Name *
Title of Text *
Author *
Publisher *
ISBN *
Edition/Year *
Select a Format *

Select a Format Electronic Text from Publisher (PDF) Braille (Handouts & Articles Only - Upon Approval) MP3 File (No Navigational Features) - Digital Text-to-Speech Voice Large Print (Upon Approval) Other (Upon Approval) Other (Upon Approval)
Copy of Book Receipt *

Maximum file size: 3MB.

Attach Files