Alternate Media Request
I have registered for the academic term identified below:
Other (specify): _____________
1. Eligibility for this service is determined by a qualified Disability Resource Center (DRC) staff member, and must be
supported by disability documentation provided by the student.
2. A new Alternate Media Request must be submitted each semester.
3. Requests for materials in alternate format must include documentation of ownership of the textbook/course
material(s) before the e-text will be provided.
4. Once a request is submitted, the DRC professional, in collaboration with the student, will determine the
appropriate format, giving preference to the format requested by the student when possible.
5. Publisher responses to e-text request may take weeks; therefore, it is essential that requests be made as soon as
possible.
6. To handle immediate need for e-text, DRC can produce e-text in house by scanning the student’s book. This
procedure requires the removal of the spine from the book. The book will be returned in a comb-bound format. In
many cases, the book will not be accepted by the bookstore for refund at the end of the semester.
7. Upon review of material to be formatted and converted, DRC will make every effort to complete the request in a
timely manner.
8. Students will be provided with one alternate format copy for each item required for academic use. These electronic
files are protected by U.S. copyright law. Any further reproduction or distribution is illegal.
9. One of the conditions identified below must be substantiated for each e-text request:
The student owns the instructional material (attach copy of original sales receipt).
The instructional material is supplied by the college/instructor to all students.
The instructional material has been purchased or ordered on the student’s behalf by the Department of
Rehabilitation or some other agency (attach copy of original sales receipt or book voucher receipt).
Other (specify): __________________________________________________________________________
10. Student questions regarding alternative format should be addressed directly to the Alternate Media Specialist at
951/222-8187 or to a DRC staff member at 951/222-8060.
I understand that any alternate media, including electronic text, that is supplied to me is solely for my own educational use. I will not copy or
distribute any such electronic text in violation of the Copyright Revisions Act of 1976, as amended (17 U.S.C. Sec. 101 et seq.). I
understand that failure to abide by this agreement may constitute a violation of the Student Code of Conduct, and/or of the policy regarding
responsible use of DRC services. I understand that a violation of that policy, including improper distribution of electronic text, may result in
suspension of DRC Services. I understand that I own one copy of the Braille or e-text book for as long as I own a copy of the book. If I sell
the book, I agree to return the Braille or e-text book to DRC.
I have read and agree to follow the above Procedures for Requesting Alternate Media:
___________________________
Phone #
___________________________
Student ID#
___________________________
Date
_____________________________________________________________ _________
Student Name (please print)
______________________________________________________________________
Email Address
______________________________________________________________________
Student Signature
______________________________________________________________________
DRC Staff Signature*
___________________________
Date
*DRC Personnel has verified that the documentation provided by the student substantiates ownership of the original material.
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