Requested Materials
Title*
Edition*
ISBN*
Requestor Info (Disability Office)
First Name*
Last Name*
Department*
Campus*
Email*
Phone*
Request Details
Request Date*
Term*
Course*
Instructor*
Student Name*
*required
Affidavit
The following requirements listed below will have been satisfied for this request:
The student, or the institution on behalf of the student, has purchased the requested instructional material.
The student has a verified disability that prevents him/her from using standard print instructional materials.
The requested instructional material is required for a course for which the student is registered or enrolled.
The request has been signed by the coordinator of services for students with disabilities or his/her designee.
The student has signed a statement agreeing to use the electronic instructional material solely for his/her own educational purposes and will not copy or duplicate the electronic instructional material for use by others.
