Alternate Format Textbook Request Form

Alternate Format Textbook Request Form

Students with documented disabilities that interfere with their ability to effectively utilize the required textbook format may receive textbooks in alternate formats as a reasonable accommodation. Eligibility is determined on case-by-case basis, based on review of appropriate documentation.
To request textbooks in alternate formats, students must complete this form for EACH textbook they are requesting in an alternate format.

To have the alternate format available to the student during the first week of classes, this form is due one week before the first day of classes. Any submission past that date may result in a delay in receiving their alternate format textbooks.

Have questions or need assistance submitting this form? Contact Student Accessibility Services at accessibility@muskingum.edu or 740-826-8280.
Name*

First NameLast Name
Muskingum ID Number*
Muskingum Email*
Example: accessibility@muskingum.edu
Course and Section Number*
Example: MUXP-101-2
Professor*
First Initial, Last Name example: J. Smith
Book Title
Author
ISBN*
***NOTE: The ISBN is important because it ensures that we can obtain the same edition, format, etc. that your course instructor has chosen for the class. You can find the ISBN on Muskingum’s bookstore website listing for your textbook.
What is the required format of your textbook through the bookstore?*

HardcopyeBookOther
What is your preferred alternate format for this textbook?*

eBookPDFWord DocAudioHard Copy BrailleElectronic BrailleOther
Student Responsibilities
I understand that I am not allowed to duplicate or share the alternate format textbook materials in any way.*

I agree
Signature

Clear
Should be Empty:

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Alternate Format Textbook Request Form

Student Responsibilities