Accessible Text Request Form

By submitting this form you are agreeing to comply with all terms of the student agreement and acknowledging that all information is accurate. Items marked with ‘*’ are required.

Alternate Format Student Agreement*
- Select All
- Student agrees to check the text they are requesting is not already available in an E-book or Accessible digital File.
- Student agrees to purchase textbooks and provide ODR with proof of purchase prior to receiving the alternate format.
- Student understands that obtaining and converting a text into an alternate format can take up to 4 weeks.
- Student understands that any digital content provided to them by ODR cannot be reproduced, transferred or shared with any other person, per copyright law.
- Student understands that if ODR cannot obtain a digital files, ODR will request to cut and scan the student’s physical copy of the book.
- Student understands that ODR will communicate through UMW emails about alternate format requests.
- Student understands that alternate format will be delivered through One Drive.
Student Name*
First Last
Student Email*
Date Needed By*
MM slash DD slash YYYY
Course Number*

Ex. PSYC 102
Instructor Name
First Last

If you know it
Title of Work*
Edition*

e.g. 1st, 2nd, 10th, etc
Author*
Copyright Date*
Publisher*
ISBN Number*
Proof of Purchase
Max. file size: 5 MB.
Assistive Technology Used
Comments

Accessible Text Request Form

Accessible Text Request Form

Disability Resources

Hours & Location

Read & Write