Disability Services Office
Request for Classroom Materials in Alternative Format
Name: Click here to enter text. Date of Request: Click here to enter a date.
Do you need training in the use of these resources? Yes No
Requested Format? Audio Braille Large Print Other
How would you like to be notified when materials arrive?
Phone: Click here to enter text. E-mail: Click here to enter text.
Course & Section: Click here to enter text. Professor: Click here to enter text.
Type of Material: Book/Textbook Handout PowerPoint Other
Title: Click here to enter text.
Author/Source:Click here to enter text. Edition: Click here to enter text.
Availability: _______________
(DSO Use Only)
Course & Section: Click here to enter text. Professor: Click here to enter text.
Type of Material: Book/Textbook Handout PowerPoint Other
Title: Click here to enter text.
Author/Source:Click here to enter text. Edition: Click here to enter text.
Availability: _______________
(DSO Use Only)
Course & Section: Click here to enter text. Professor: Click here to enter text.
Type of Material: Book/Textbook Handout PowerPoint Other
Title: Click here to enter text.
Author/Source:Click here to enter text. Edition: Click here to enter text.
Availability: _______________
(DSO Use Only
Course & Section: Click here to enter text. Professor: Click here to enter text.
Type of Material: Book/Textbook Handout PowerPoint Other
Title: Click here to enter text.
Author/Source:Click here to enter text. Edition: Click here to enter text.
Availability: _______________
(DSO Use Only)
Course & Section: Click here to enter text. Professor: Click here to enter text.
Type of Material: Book/Textbook Handout PowerPoint Other
Title: Click here to enter text.
Author/Source:Click here to enter text. Edition: Click here to enter text.
Availability: _______________
(DSO Use Only)
Course & Section: Click here to enter text. Professor: Click here to enter text.
Type of Material: Book/Textbook Handout PowerPoint Other
Title: Click here to enter text.
Author/Source:Click here to enter text. Edition: Click here to enter text.
Availability: _______________
(DSO Use Only)
Course & Section: Click here to enter text. Professor: Click here to enter text.
Type of Material: Book/Textbook Handout PowerPoint Other
Title: Click here to enter text.
Author/Source:Click here to enter text. Edition: Click here to enter text.
Availability: _______________
(DSO Use Only)