Accessibility Resource Center
Accessibility Resource Center
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Document Conversion Request Form

Name: _____________________ Banner ID: _____________ Phone: ___________

Semester: _________                 Date: ___________         Time: __________

 

Requested Format:

 

_Braille   _E-Text (CD-R)   Large Print:  Style: __ Font: __Other: _________

Item(s) Submitted: (check the box for the particular item that is being requested to be re-formatted)

Book□       Syllabus□         Test□         Notes□      Handout□

Number

Course Name & #

Professor

Book Information

HandoutInformation

1

   

Title

Title

         
     

Author

 
         

2

   

Title

Title

     

ISBN#

 
     

Author

 
     

Year

 

3

       
     

Title

Title

     

Author

 
     

Year

 

 

Items Completed:

 

Number

Item

Student Contacted

Professor Contacted

Picked Up By

Pick Up Date

1

 

 Y □      N □

 

      Y □      N □

   

2

 

Y □      N □

    Y □      N □

   

3

 

Y □      N □

 

      Y □      N □

   

You must be pre-approved to receive this accommodation prior to filling out this request. Please see the Director if you have any questions.  You are required to submit a copy of the item needing converting at time of request. Textbooks will be unbound and run through a fast-speed scanner.  The textbook will be returned to you unbound.  Work orders are done on a first-come, first-served basis.  We will make every effort to provide the alternative format to you within 2 business days.

I agree to adhere to copyright laws set forth on Textbook conversions. I also agree to use this CD for my own personal needs. I will not share any of the information contained in this CD with others. I understand the conditions outlined in the paragraph above and agree to these terms.

Signature: ______________________________________                 Date: ______________