Alternate Media Request Form
Disability Resource Programs
Educational Access Center, Bell Tower Room 1541
Telephone (V/TTY) (805) 437-3331 • Fax: (805) 437-8529
INSTRUCTIONS:
Please complete a separate form for each item to be processed. Fields marked with an asterisk (*) are required.
Submit completed form along with all materials to be processed to the Educational Access Center.
CONTACT INFORMATION *Date: _______________________
* Name: __________________________________________________________________________________
* Contact phone: (____)
* Email Address: _______________________________________
TYPE OF MATERIAL PREFERED METHOD OF DELIVERY
Book/Online Material/Handouts (Please fill out other side)
Class reader
Other __________________________________________
CD
Copy to student’s memory stick
E-mail attachment
Other ___________________________________________
IMPORTANT INFORMATION – PLEASE READ
1. Every effort will be made to complete the transcription request as quickly as possible, generally within four
weeks. Timeline for completion is determined based on the type, complexity and length of the material, in
addition to the original format of the material to be converted as well as the format the material is to be converted
to such as literary Braille, Nemeth Braille, tactile images, etc.
2. Requests may be fulfilled in installments.
3. If e-text is available, large print requests will be formatted in Arial font size 18 unless otherwise specified.
4. A syllabus or reading list must be submitted for a large item
(e.g. text book, article) electronically or as hardcopy.
5. For book requests:
a. Disability Resource Programs (DRP) will only provide alternate media in the formats requested by the
student. Formats available from DRP are listed on the back of this form under Part 2.
b. All requests for text format files will be provided in rich text format (RTF). RTF files are compatible
with most word processing software including Microsoft Word and with screen readers such as JAWS
and Kurzweil.
c. Book front matter (FM) will be provided only if requested. FM usually consists of all material in a book
that precedes the main body text, such as the title page, copyright page, table of contents, dedication, and
preface. If you would like to request a PDF file of the book’s front matter, please check the following
box:……………….………………………………………………………………………..………..
FM
d. Book back matter (BM) will be provided only if requested. BM usually consists of the parts of a book
that appear after the main text, such as bibliography, index and appendixes. If you would like to request a
PDF file of the book’s back matter, please check the following box:………………………...……
BM
e. Student must present documentation of their course registration and proof of textbook purchase.
f. For the purpose of expediting book requests, the student may choose to provide his/her own textbook for
scanning. Note: To do this, the text spine must be removed for scanning and then rebound when
completed. The book will no longer be acceptable for buy back at the bookstore.
Student Initials: ________ provided own material/book on date: __________.
