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Alternate Media Request Form

Steps to requesting alternative media:

  • Obtain approval from your LAP specialist.
  • Review the LAP's Alternative Media Policies and Guidelines.
  • Enroll in classes during Priority Registration.
  • Complete this form immediately following Priority Reg.
  • Check your email frequently for requests for more information, completion notifications, etc.
  • Make and attend an assistive technology training appointment.
  • Email textbook receipt to or bring textbook/receipt to the LAP office. 

Note: Only required textbooks will be processed unless noted in the "Other Info" box.

Student and Course Information
Please select your preferred format/mode of accessing your textbooks:
Pick up and/or show textbook/receipt location:
By submitting this form, I confirm that:
  • I have obtained, or will obtain, ownership of the instructional material
  • I agree to the release of documents verifying my disability if required by the publisher
  • I understand that all of the alternative media supplied to me is only 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 L.A.P. services. I understand that a violation of that policy, including improper distribution of electronic test, may result in suspension of L.A.P. services.
  • If I sell, return, or no longer have ownership of the original textbook, I will return the alternative media to the L.A.P. or delete the electronic version.
I have read, understood, and agree to all of the above statements. *