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Request for Books in Alternative Format

Saturday, June 15, 2024

This form is for students requesting textbooks in an accessible format.


Student Understanding

As a student registered with the Office of Disability Services and approved to receive books in an alternative format, I understand that I may request an alternative format through the Office of Disability Services if the alternative format is not available for me to purchase. Once the request form is received, the Office of Disability Services will request the alternative format from the publisher. Alternative formats requested from the publisher may take 4 weeks or longer to obtain. If I have questions or need assistance completing the request form, I will inform the Office of Disability Services.

Books in Alternate Format Agreement

I agree to purchase or rent the book I am requesting in an alternative format. I understand I must provide proof of purchase or rental to the Office of Disability Services before an alternative format is released to me. I also agree that I will not distribute or copy any of the alternative formats provided to me through Disability Services. It is my responsibility to use this material for the intended class and for educational purposes only.

If provided an alternative format in a version other than an electronic format, I am responsible for returning items checked-out prior to receiving alternative formats for future semesters and if not returned may result in my account being charged for the replacement cost and a registration hold placed on my account.

I understand that typing my full name in this box constitutes a legal signature confirming that I acknowledge and agree to the understandings above.

Please provide your UA-PTC e-mail address.

Format Preference:


The Course/Section is available on your class schedule and all other required information can be obtained at

Please enter your textbook information below. If you are requesting more than six textbooks, please submit an additional form.


(ex. ENGL 0111)

(ex. ENGL 0111)

(ex. ENGL 0111)

(ex. ENGL 0111)

(ex. ENGL 0111)

(ex. ENGL 0111)

Attach/Upload Proof of Purchase or Rental
Add another