Minnesota State Services for the Blind Audio Transcription ...



Audio, E-text, Large Print Order FormCustomer/student Information: First Name __________________________Last Name______________________________Email _______________________________ Phone: _____________________________(Required for file/transfer download)Address_______________________________________________________________ House # and streetCityStateZipQualifying Print Impairment: FORMCHECKBOX Visual FORMCHECKBOX Reading FORMCHECKBOX PhysicalCustomer Agreement and Copyright Notice FORMCHECKBOX attached FORMCHECKBOX on file with SSBTitle of book/material _____________________________________________ Edition_________Author ______________________________ Publisher _______________________________Copyright year__________________ISBN__________________________Transcription type and format:Human-narrated audio FORMCHECKBOX File transfer/download (DAISY format) FORMCHECKBOX SSB cartridge (DAISY format playable in NLS digital players) FORMCHECKBOX CD by: FORMCHECKBOX DAISY format or FORMCHECKBOX MP3 (must be copyright owner) FORMCHECKBOX Customer cartridge or flash (thumb) driveE-text FORMCHECKBOX PDF by: FORMCHECKBOX file transfer/download or FORMCHECKBOX customer flash/thumb drive FORMCHECKBOX Word by: FORMCHECKBOX file transfer/download or FORMCHECKBOX customer flash/thumb drive FORMCHECKBOX DAISY by: FORMCHECKBOX file transfer/download or FORMCHECKBOX customer flash/thumb driveLarge print FORMCHECKBOX Electronic copy by: FORMCHECKBOX file transfer/download or FORMCHECKBOX customer flash/thumb drive FORMCHECKBOX Hard copy with comb bindingThis order is for: FORMCHECKBOX School and is needed by ________________________. (Please provide reading schedule when able so that we can best match your classroom reading needs.) FORMCHECKBOX Book club and is needed by ______________________. FORMCHECKBOX Business and is needed by ______________________. FORMCHECKBOX Vocational and is needed by ______________________. FORMCHECKBOX LeisureTranscribing Instructions: Please review the document, What is Transcribed?, for a listing of what is routinely transcribed when customers do not make specific requests. If you want your transcription to be different, please tell us below (such as specific pages or sections to transcribe or omit, whether to announce page numbers on the recording, what type of reference notes to record, whether to record or omit charts, tables, graphs, etc.): ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________For Schools: If you are a school requesting transcription for an eligible student, please provide:School name: __________________________________________________________________Contact: _______________________________________________________________________Mailing address: ______________________________________________________________________________________________________________________________________________Phone number (_______)________________ alternate (_______)_________________Email: ____________________________________________________________________Purchase Order Number: _____________________School billing contact, address, and phone number, if different: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________7. Authorized Signature:I HAVE REVIEWED THE MINNESOTA STATE SERVICES FOR THE BLIND COMMUNICATION CENTER TRANSCRIPTION POLICIES AND THE WHAT IS TRANSCRIBED? DOCUMENTS.Authorized Signature: ______________________________________Date: _________________ ................
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