Alternative Text Request Form Company Student's Name * Enter your first and Last name Student ID number * Full Title of Textbook * Author * Publisher * Edition ISBN - International Standard Book Number * Course (for which the textbook is required) * Instructor's Name * Term * Spring Summer Fall Year * 2018 2019 2020 2021 2022 Attach Syllabus Here Please agree to the following statements: I agree that I have purchased the instructional text for which I have requested an alternative format. I agree that I am enrolled for the semester and the particular course(s) for which I am requesting alternatively formatted materials. I agree that I will not copy or allow anyone else to copy the alternatively formatted materials. I agree that I will not share the alternatively formatted materials with any other party. I understand that any violation of the above statements and of this agreement may constitute a violation of federal and/or state laws and may result in civil or criminal prosecution, payment of fines or other monies to the copyright holder, and/or incarceration. By entering my full name below and submitting this form, I am agreeing to be legally bound by the above agreement. I Agree * I agree to the above statements.
