Sacramento State - SSWD Alternative Format Request Form

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Alternative Format Request Form

Please complete a SEPARATE form for EACH REQUEST to be submitted (i.e. each textbook, workbook, course reading packet, etc. will require a separate request form). Please note that you will still need to bring in the textbook and proof of purchase in order for us to process your request. Please allow 4 to 6 weeks for delivery of alternative format after textbook is available.


Alternative Format Request Form Instructions

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

REQUESTOR INFORMATION

*Sac State ID:		*Home Phone:
*First Name:		Cell Phone:
*Last Name:		*Email:
		*Verify Email:

COURSE INFORMATION

*Semester:
Fall
Intersession
Spring
Summer

*Course Name:	Example: BIO 160
*Instructor:	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/RFB&D (requires specialized software/players)
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 below to continue. The request will not actually be submitted until you have reviewed the information and 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.