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ALTERNATIVE TEXTBOOK REQUEST
I, , am requesting an alternative textbook for the following
courses for semester 20___.
1. Course Prefix & Number: Instructor:
Name of Course:
Name of Text:
Author: ISBN:
2. Course Prefix & Number: Instructor:
Name of Course:
Name of Text:
Author: ISBN:
3. Course Prefix & Number: Instructor:
Name of Course:
Name of Text:
Author: ISBN:
4. Course Prefix & Number: Instructor:
Name of Course:
Name of Text:
Author: ISBN:
5. Course Prefix & Number: Instructor:
Name of Course:
Name of Text:
Author: ISBN:
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6. Course Prefix & Number: Instructor:
Name of Course:
Name of Text:
Author: ISBN:
7. Course Prefix & Number: Instructor:
Name of Course:
Name of Text:
Author: ISBN:
The above is a list of all alternative texts that I am requesting. I understand that if there
are any changes, it is my responsibility to notify Disability Services immediately.
Signature: Date:
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