Fillable Student Accessibilities Services Electronic Text Materials Request (University of South Florida)

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Student Accessibilities Services Electronic Text Materials Request (University of South Florida)

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STUDENT ACCESSIBILITY SERVICES
University of South Florida | 4202 E Fowler Avenue, SVC 1133 | Tampa, FL 33620-6921
813-974-4309 | usf.edu/sas
Student Accessibilities Services
Electronic Text Materials Request
Student Name (First, Last) _______________________ USF ID # _______________________________
Phone # ______________________________________ Email __________________________________
Semester Fall 202_____ Spring 202_____ Summer 202_____ A B C
Date of Request _______________________________ *Proof of Purchase Provided Yes
*SAS does not require proof of purchase to submit this request; however a proof of purchase for all textbooks is required before
converted materials are picked-up by the student. Additionally, by my submission of this request, I certify that I have read and
understand the E-Text Guide and Procedures for Obtaining Course Textbooks in Electronic Format.
REQUEST ELECTRONIC CONVERSION OF THE FOLLOWING TEXTBOOKS
Title of Book
Author
Copyright
Date/Edition
Course/Professor
ISBN
1)
2)
3)
4)
5)
6)
PICK-UP AGREEMENT FOR ELECTRONIC FORMAT TEXT AND COURSE MATERIALS
I _________________________________ have received an electronic version of the above listed
textbooks from SAS. These materials are copyright protected and are for my sole use because of my
documented print-related disabilities. In order to receive these materials I agree to the following:
1. That I have provided SAS with “proof of purchase” for a printed version of the e-text materials.
2. This e-text is for my use only. I will not copy, reproduce, or shared these materials in any manner.
3. Violation of this agreement may result in loss of e-text privileges and possible disciplinary action.
Student Signature: _____________________________ Date of Receipt: _________________________
SAS Signature: _________________________________ Date of Delivery: ________________________
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Student Accessibilities Services Electronic Text Materials Request (University of South Florida)

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Completed 11 February 2021

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