Alternative Format Request Form
*All students must register with the Office of Disability Resources before completing this form.
Students must complete this form when requesting books in electronic formats as an accommodation due to a
disability. All materials will be provided to students in an electronic format delivered via email unless the student
requests otherwise or doing so does not provide the student with equal access to their course materials. All
students must provide ODR with a proof of purchase for the textbooks being requested. This is required even if
the student brings in their own books to be cut.
Personal Information:
Name:
Student ID #:
Email:
Date:
Phone #:
Current Term:
Book Information:
Title:
Title:
Author:
Author:
Edition:
Edition:
ISBN#:
ISBN#:
Copyright Year:
Copyright Year:
Publishing Company:
Publishing Company:
Title:
Title:
Author:
Author:
Edition:
Edition:
ISBN#:
ISBN#:
Copyright Year:
Copyright Year:
Publishing Company:
Publishing Company:
Title:
Title:
Author:
Author:
Edition:
Edition:
ISBN#:
ISBN#:
Copyright Year:
Copyright Year:
Publishing Company:
Publishing Company:
3201 Arch Street, Suite 210, Philadelphia, PA 19104 | Tel: 215.895.1401 | TTY: 215.895.2299 | Fax: 215.895.1402 | drexel.edu/odr