UC Clermont - Alternate Format Request

First Name:

Last Name:

UC ID:

The UC ID is your student identification number.

Email:

Course ID & Section Number:

Media Type:

Book

Article

ISBN:

In which format do you prefer to receive the alternate text?

Audio (MP3)

Digital (PDF or DOC)

AR requires proof of purchase before we will process your request. You can attach the receipt or bring it to our office.

I will upload the receipt now.

I will fax, email, or bring the receipt to the office later.

Upload the receipt:

Word documents, image files and PDFs only

AR requires a copy of your syllabus before we will process your request. You can attach the syllabus or bring it to our office.

I will upload the syllabus now.

I will fax, email, or bring the syllabus to the office later.

Upload the syllabus:

Word documents, image files, and PDFs only

Specific message to Alternate-Format Media Coordinator:

I acknowledge that I have received the above requested material and that it is issued to me based on my need as a student with a print-related disability. Futhermore, I state that I own or rent a copy of the original textbook for each alternate media title that I have requested.

I also acknowledge that the above requested material is in a specialized format and any further reproduction or distribution of the material is an infringement of copyright law.

Electronic Signature:

Date:

iFrame Code