REV 4.29.19
Office of Supportive Services for Students with Disabilities
Agreement for E-Text on CD, DVD, or Flash Drive
Student name (please print) _______________________________________________
Student I D number ______________________________________________________
For access to E-Texts, you must provide a copy of the receipt for each book listed below. The receipt
will be retained by the Office of Supportive Services. Failure to provide a receipt will result in your
inability to receive the electronic material.
As part of your accommodation, you have been provided with a copy of the listed text books on
__ Firefly __ USB __ Other
Title(s) of text book(s) provided electronically:
__________________________________________________________________________________________________________________________________
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__________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
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E-text service has been provided for your educational benefit by CCAC's Office of Supportive Services
for Students with Disabilities." Failure to comply with the terms below will compromise your future
access to this type of learning support and may result in other penalties as described below.
Signature constitutes agreement to the following:
I will not copy or share this electronic material with others and I understand that unauthorized
reproduction and/or sharing of the provided electronic material will constitute a breach of
contract and subject me to appropriate penalties and fines.
Student Signature: ________________________________ Date: _________________
Date Available to Student: _________________
Supportive Service Signature: ______________
__________________
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