Yes No
The student is responsible for informing Rose Desmond, Alternate Media Specialist at (925) 969-2174,
Student Services Center 238 DSS Office, whenever changes occur that affect the student’s need for alternate
media services. When textbooks or course materials are required by students before they are available in
alternate formats, students will be directed to the High Tech Center to use a “reading” software that scans and
reads printed material. E-texts and tapes will be used solely for the eligible student’s own educational purposes
and will not be copied or duplicated for use by others.
I have read, understand and agree to the above requirements I am aware that failure to comply with the above
conditions may result in the termination of this service for the semester.
Did you received Alt Media last Semester
By typing your name on this contract it is your signature:
Alternate Media Services will only be provided to students who have a verified disability and whose disability
related functional limitations prevent them from reading regular print. Students must be enrolled in the courses
before ordering books in alternate media. Material provided to the AMS for the purpose of conversion to
alternative format will be disassembled and returned to the student in its altered condition. The AMS will not
be held responsible for any damage to the materials that occur as a result of conversion to alternative format.
FA SP SU
Name:
Date:
Textbook Name:
Requested Date:
Student ID#:
Edition:
Phone #:
ISBN#:
Section #:
Course info:
E-Mail:
Textbook Name:
Textbook Name:
Edition:
Edition:
ISBN#:
ISBN#:
Alternate Media Services (AMS) Application & Contract
