Alternate Format Textbook Request Form
If you have an accommodation to receive alternate format materials (electronic texts) as part of your GCC Accommodation
Agreement, please complete and submit this form to the Office of Disability Services as early as possible. You may enter
your information and print it out (it’s a fillable form), and then fax it to 413-774-7884, drop it off at the Wellness Center in
C423, take a picture of the finished form and email to DS-Students@gcc.mass.edu, or mail to Office of Disability Services
at the address above. Note: If we need to request either a digital or hard copy text from the publisher, it may take
4-6 weeks for you to receive the file.
Name Student
I
D
#
Email Request
Da
t
e
Course Code
(e.g. ENG101)
Edi
t
ion
Source AT BS LA Pub Archive
Purchase Proof (date/initials
)
Format for Distribution
CD FD GD Email
Email for pick-up/download
Source AT BS LA Pub Archive
Purchase Proof (date/initials
)
Format for Distribution
CD FD GD Email
Email for pick-up/download
To comply with Publisher copyright laws, we cannot release the electronic copy
to you without proof of purchase, rental, or ownership.
Proof may be in the form of a receipt (either paper or electronic) or your physical book.
One College Drive,
Greenfield
,
MA
01301-9739
WELLNESS
CENTER
Disability Services
PHONE (413
)
775-1332
FAX (413
)
77
4
-
7884
DS-Students@gcc.mass.edu
Course Code
Course Title
Course Title
