Alternative Format Request Form

Alternative Format Request Form Instructions

Please note that you will still need to bring in the textbook andproof of purchase in order for us to process your request. Please allow 4 to 6 weeks for delivery of alternative format.

Instructions: Complete a SEPARATE form for EACH REQUEST submitted. Please note that fields with an asterisk (*) are required.

REQUESTOR INFORMATION

*Sac State ID:

*First Name:

*Last Name:

*Home Phone:

Cell Phone:

*E-mail:

*Verify E-mail:

COURSE INFORMATION

*Semester:

  • Fall
  • Intersession
  • Spring
  • Summer

Example: BIO 160



Example: J.W. House



MATERIAL INFORMATION

*Title of Material:

*Author:

*Publisher:

Edition:

*ISBN:

  • *Material Type:
  • Article
  • Book
  • Other: Input Other Material Type

  • *Format Requested:
  • Audio/Digital Audiobook (must be requested from Learning Ally/Bookshare)
  • Braille
  • PDF (From Publisher)
  • Kurzweil 3000
  • Large Print
  • Word (Rich Text Format)
  • Other: Input Other Format

COMMENTS OR SPECIAL INSTRUCTIONS: (500 Characters)









Note:   Press the "Continue" button to continue. The request will not actually be submitted until you have reviewed the information and you press the "Submit" button on the second confirmation page.

Please inform SSWD at sswd@csus.edu if you  encounter any problems accessing the SSWD web site.