Empire State College



Mitchell CollegeStudentAlternate Format Policy and ProcedureStudent: _________________________________________Major: ________________________Email address: _____________________________Cell Phone: ______________________Date: ___________________________It is your responsibility to gather your assigned text book information on the Alternative Format Worksheet form from your instructor or the bookstore and return the filled out form to your specialist. Book requests may take as long as 4-8 weeks to fulfill, depending on the source of the alternative format and the date of request.You need to submit a receipt or packing list to prove that the titles have been purchased before receiving an e-text copy. You agree that alternative format materials are strictly intended for your individual use and that duplication is prohibited by copyright laws. All loaned LRC materials are to be returned at the end of the plete the table on the next page with the identifying information of the textbook(s) you are seeking. Please indicate your preferred format:___ Audio___ RFBD audio ___ Large print___ Braille___ Electronic text file*___ PDF*I have reviewed the above policies and procedures for the request and use of alternate text.Student signature: _______________________________________________Date:____________________________________I am aware that I am entitled to alternate format. I choose not to request alternate format at this time.Student signature: _______________________________________________ Date____________________Alternate Format WorksheetStudent name: _____________________Date/Semester: ______________________Specialist:______________________________Course/InstructorTitle/editionAuthorISBNPublisher Notes:Preferred Format:_____________________Course/InstructorTitle/editionAuthorISBNPublisher Notes:Preferred Format:_____________________Course/InstructorTitle/editionAuthorISBNPublisher Notes:Preferred Format:_____________________Course/InstructorTitle/editionAuthorISBNPublisher Notes:Preferred Format:_____________________Possible Formats: Audio (RFB&D, MP3), Braille, Large Print, Electronic text file (Kurzweil, MS Word, PDF) ................
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