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Alternate Media Request Form

Step 1: After applying for DSPS services, meet with your specialist and request that the electronic text, Kurzweil, braille, tactile diagrams, large print, closed captioned video, and/or taped text be approved on you Student Education Contract (SEC).

Step 2: After registering for your classes, determine which books you will require on audio tape, large print, braille, or electronic text. This information can be obtained by calling the instructor of the course. Within 2 weeks of the start of the course, you may go to the Cuesta College Bookstore Website  and select the Textbooks link to get information on required and optional books for your courses.

Step 3: Fill in the textbook information below. This form may also be used for video tapes, materials on reserve in the library, and other instructional materials, please enter as much information as you can.  ALL LINES MUST BE COMPLETED FOR TEXTBOOKS!

Step 4: If you haven't already, please read the Alternate Media Request Procedures.

Step 5: Fill out and submit the Alternate Media Request form. You have three options here. 

  1. You may fill out this electronic form below and press the SUBMIT button at the bottom of this form to submit it via e-mail. You are strongly encouraged to print out a copy for your records before pressing the SUBMIT button!
  2. You may fill out the electronic form below, print it, sign it, and deliver it to DSPS Support Services.
  3. You may obtain a paper version of this form, fill it out, sign it, and turn it in at the DSPS Support Services Desk.

Step 6: Most requests for electronic text, large print, and braille require your signature and proof that you have purchased the book. If you submit the form electronically, we will print out a copy of the request and you will need to come to the DSPS Support Services Desk to sign the request form and to turn in copies of your receipt. Please submit this form as soon as possible after you register for classes to assure textbook availability.

Step 7: If you submit the form electronically, you will receive an e-mail or phone call to let you know that your request was received. If you do not hear from us within 2 working days, please call (805) 546-3100 x2825 and ask if we received your Alternate Media Request form.

Remember, you must click the submit button
at the bottom of the form to submit your request!

*Fields marked with a red asterisk are required

Student Information

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Course Information

This form allows you to enter up to two (2) books for a single course. Comments or notes may be entered at the end of the form.

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First Textbook Information

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Preferred Format for this book:  
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Second Textbook Information

Preferred Format for this book:  

Terms and Conditions for the use of Alternate Texts

I understand that any alternative text, which may be supplied to me, is solely for my own educational purposes. I will not copy or distribute any such alternative text in violation of the Copyright Revisions Act of 1976, as amended (17 U.S.C. Sec. 101 et seq.). I understand that failure to abide by this agreement may constitute a violation of the Student Code of Conduct, and or the college policy regarding the responsible use of DSPS services and I understand that a violation of that policy, including improper distribution of electronic text, may result in suspension of DSPS services.

   

Please list any regarding your textbooks below:

IN GENERAL, 2 TO 6 WEEKS NOTICE IS REQUIRED TO OBTAIN A TEXTBOOK IN AN ALTERNATE FORMAT. BRAILLE TAKES SLIGHTLY LONGER. THE DSPS DEPARTMENT WILL MAKE EVERY ATTEMPT TO PROVIDE MATERIALS AS PROMPTLY AS POSSIBLE. HOWEVER, LATE REQUESTS WILL RESULT IN A DELAY IN PROVIDING COURSE MATERIALS.

      

If the form is filled out correctly, when you press the submit button you will be sent to a web page which confirms that your request was successfully submitted. If you are unable to get the form to validate, please print it, sign it, attach copies of your book receipts, and mail or deliver it to: Alternate Media Facilitator, DSPS, Cuesta College,  P.O. Box 8106, San Luis Obispo, CA 93403-8106.

Page maintained by dspsweb@cuesta.edu. Last modified: 11/14/2003.