ROCK VALLEY COLLEGE
DISABILITY SUPPORT SERVICES
Student Alternative Text Request Form
________________________________________________________________________
If you need your textbooks provided in an alternative format (ex., large print, cassette tape, Braille, CD) this form must be completed and
turned in to the Coordinator of Disability Support Services. Due to the amount of time required to provide this accommodation, a minimum
of six weeks time must be given to complete the preferred format. Students who request an alternative text choice without sufficient advance
notice may be offered an alternate format which will be completed on a first-come, first-served basis and cannot be guaranteed by the start of
classes.
TERMS AND AGREEMENTS FOR ALTERNATE TEXT CONVERSION:
All students requesting alternate text must be registered with the DSS office.
 The DSS office may, on occasion, only be able to convert the chapters or sections of the text book(s) that are required for the class.
For this reason you must present the DSS office with a copy of all course syllabi before conversion can be started.

Only books/materials that have not been marked or highlighted will be accepted. In addition, some books that contain a lot of graphs,
pictures, symbols, numbers, etc. may not be possible due to the difficulty of the OCR software recognizing the information.

Students are required to purchase a hard copy of all textbooks. Due to copyright issues, the DSS office must see a copy of the
textbook and/or receipt before conversion can begin.

In accordance with copyright law, converted material may not be copied and/or re-sold.

All CD-ROMs, discs and cassette tapes should be returned to the DSS office at the end of the semester so that they are available for
re-distribution as needed.

The text conversion process requires that book bindings be removed for scanning. Books will be re-bound once the process is
complete. Books that require binding other than spiral binding will not be accepted by the bookstore for buy-back. (Please keep in
mind the bookstore does not guarantee buy back of any books, including those that have been scanned).
I have read the above and agree with the specified terms of agreement.
_________________________________________
Student’s Signature
Student’s Printed Name:____________________________________________
________________
Date
Term Needed___________________
DISABILITY SUPPORT SERVICES (DSS)
Alternative Text Request Form
Note: This form needs to be completed and submitted (with all textbooks) to the DSS office before text conversion can begin. Also, Please be
sure to fill out a separate line in book information section for each book.
General Information:
Today’s Date:
Term:
Student’s Name:
Student’s Phone:
Student ID#
Date Flash Drive Provided:
Book Information:
Book #
Course/
Section
Book Title
Ed.
Publisher
ISBN#
Copyright
Date
Format
Book #
Course/
Section
Book #
Drop
Off
Date
Book Title
E-Text
Pick up
Date
Ed.
Book
Pick up
Date
Flash
CD
Publisher
Book #
ISBN#
Drop
Off
Date
E-Text
Pick up
Date
Copyright
Date
Book
Pick up
Date
Format
Flash
CD
Revised 4/18/12