SECTION 1.

First Name:             *required

Last Name:             *required

E-mail:          *required (example: sgoodman@albion.edu )
Enter your complete email address

Class standing: 1st year  2nd year  3rd year  4th year

Semester:             Fall Spring Summer  *required          Year:    *required (example yyyy: 2005)

Phone number:             *required (include your area code)

KC Box:                       *required (Albion College campus mailbox number)

SECTION 2.

You MUST be registered with the Learning Support Center to receive electronic text.

Electronic Text requests must include all the information indicated in sections 1 & 2. Requested information in Section 2 can usually be found by searching the book title using  http://google.com

The Assistive Technology Office will make every effort to obtain materials in a timely manner and in the specific format requested. However, consideration will be given to the most expedient manner and format available in the fulfillment of student requests. To that end, students may find themselves in possession of materials in a variety of formats depending upon availability.

Subject Area:   None specified Anthropology and Sociology Art Art History Athletic Training Biology Chemistry Computer Science Earth Science Economics and Management Education English Foreign Languages Geological Sciences History Mathematics Music Philosophy Physical Education Physics Political Science Psychology Religious Studies Speech Communication Theatre

Class:                         *required (example: CHEM211_2M)
Must include SUBJ, CRS # and SEC as indicated on Class Schedule.

Professor:                    *required (example: Andrew French)
Indicate the full name of the professor.

ISBN #:           
No spaces between numbers or characters.

Author's Name:

Book Title:      

Book Edition:   (example 5) Enter the number only.

Publisher:       

Preferred Format: None specified Braille E-Text Audio-specify in Section 3. Other Large Print-specify in Section 3. Other Color Background-specify in Section 3. Other

SECTION 3.

Other requests must include all the information indicated in sections 1 & 3.

Other requests: (Please be specific.)

If you have difficulty with this form please contact Shel Goodman at sgoodman@albion.edu