Request Form for Alternate-Format Textbooks

To download and print a pdf click here.  Please return to Deborah Levi in the SMC Campus Center, Rm 317

CONTACT INFORMATION
REQUIRED DOCUMENTATION:
A copy of your textbook receipt must be scanned and attached or mailed or faxed to ESDS.
Other option:
LIST OF BOOKS
Please list the full name of the book, edition, ISBN #, author and publisher.
I AGREE TO THE FOLLOWING STATEMENTS:
1) I have purchased the textbook indicated above and attached a copy of the receipt.*
2) I have a disability that prevents me from using the textbook purchased.*
3) I will not copy or further distribute the electronic files or other alternatives format of this textbook for any other purpose.*
4) I agree to abide by the Copyright Law of the United States of America, as amended (17 U.S.C. Sec. 101 et seq.) and the applicable code of conduct of the University of Maryland.*
5) I agree not to use, sell, transmit, publish, broadcast or otherwise disseminate any version of this textbook which has been modified for accessibility purposes, to anyone without the prior written permission of the Publisher.*
AUTHORIZATION AND SUBMITTION:
By clicking "Submit" I verify and agree to the above statements.