Alternate Media Request Form

Please thoroughly complete the following form. After submitting the form, please check your email frequently. You will receive a confirmation email and possibly a request for more information from our e-text provider.

Requests should be submitted at least 6 weeks before classes begin to help ensure timely delivery so please register for your classes during Priority Registration, buy your books and submit this form as soon as possible. Only required textbooks will be processed unless noted in the "Other Information" box below.

Remember, before submitting this form you must have:

  1. Obtained approval for alternative media from your LAP specialist.
  2. Registered for classes.
  3. Purchased your textbooks. Please bring a copy of the receipt to the LAP.

In general, 2 to 6 weeks notice is required to obtain a textbook in an alternate format. Braille can take longer. The LAP department will make every attempt to provide materials as promptly as possible, However, late requests will result in a delay in providing course materials.

By submitting this form I confirm that I have purchased the instructional material and that I agree to the release of documents verifying my disability if the publisher requires a copy. I understand that any e- text, which may be supplied to me, is solely for my own educational purposes. I will not copy or distribute any such e-text in violation of the Copyright Revisions Act of 1976, as amended (17 U.S.C. Sec. 101 et seq.). I understand that failure to abide by this agreement may constitute a violation of the Student Code of Conduct, and/or the college policy regarding the responsible use of LAP services and I understand that a violation of that policy, including improper distribution of electronic text, may result in suspension of LAP services.





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Last Modified Dec 10, 2014