SHSU Services for Students with Disabilities (SSD)
ALTERNATIVE FORMAT TEXT REQUEST FORM
Student Name: ID #: Semester:
Phone #: Email address:
NoPersonal Learning Ally Account? Yes VA or DARS Client? Yes No
)
What software do you use to read your eText books?
What format works best for your eText books? PDF RTF Other (describe
Proof of Purchase will be required at time of pick up for all Alternative Format Books.
Use of Alternative Texts must be approved by the SSD Director or his designee.
1. Title:
Author(s):
Edition: Publisher:
ISBN #: (usually s
tarts with 978 and is 13 digits long)
Course: (i.e. ENGL 1301.01) Instructor:
Requested Format: Audio (if
approved)
eText
2. Title:
Author(s):
Edition: Publisher:
ISBN #:
Course: In
structor:
Requested Format:
eText
Audio (if approved)
3. Title:
Author(s):
Edition: Publisher:
ISBN #:
Course: Instructor:
Requested Format:
eText Audio (if approved)
4. Title:
Author(s):
Edition: Publisher:
ISBN #:
Course: Instructor:
Requested Format:
eText Audio (if approved)
5. Title:
Author(s):
Edition: Publisher:
ISBN #:
Course:
Instructor:
Requested Format:
eText
Audio (if approved)
Sen
d Request To: DISABILITY@SHSU.EDU
We will contact you as soon as complete or should we have questions.
For requesting additional books – please complete additional form.
Book Req. 03.25.14
