Document 15479608

Please provide the Disability Resources office with the following information in order to obtain a
textbook in an electronic version from the publisher. (Please note: It may take up to four weeks to get
files from a publisher) Also note that you are required by copyright law to purchase a copy of the
book prior to obtaining an electronic version.
Your Name ____________________________________________________________________
Your E-mail Address _____________________________________________________________
Today’s Date ___________________________________________________________________
Semester Needed _______________________________________________________________
Title __________________________________________________________________________
Author ________________________________________________________________________
Publisher ______________________________________________________________________
Edition Number ________________________________________________________________
Copyright Year _________________________________________________________________
ISBN # ________________________________________________________________________
Course Name __________________________________________________________________
Course Number _________________________________________________________________
Professor’s Name _______________________________________________________________
Date of Book Purchase/Price of Book _______________________________________________
Do you have
PC _____ MAC _____
What operating system (such as Windows 7) do you use? ______________________________
Please sign and date below that you understand that once you receive an electronic textbook, you
are the only person who is allowed access to the book and you are not permitted to make copies or
share the book with any other person, including other students in the class. Unless you choose to
keep the hardcopy of the book, you must delete the files from your computer at the end of the
Some publishers require us to give your name in order to obtain files. By signing below you are also
giving permission for ODR to give your name to publishers of books you are requesting.
Your Signature
Today’s Date
Rev 9/2013