Alternative Media Request Form

General Information
Contact Preference The best way to contact me is:
Schedule Information
Please list the classes in which you will need alternative media. If you do not yet know your class schedule, but you know you will need alternative media services, skip this section and request an appointment below.
Class Name and Number Item # Instructor Name
Additional Textbook Information
File Format Preference (Optional)

Files are typically available in TEXT, RTF, Word/DOC, PDF or MP3/Audio formats. If you would like to request a specific format, please note it here:


If you have not entered class information above, you must meet with the Assistive Technology Specialist to discuss your alternative media needs for this quarter. The DRC will contact you to schedule this appointment.