ACCESS Alternate Text Agreement

First Name

Last Name

I understand the following

As an ACCESS student with current alternate text format accommodations for the current semester, I understand the following:

I understand that as an ACCESS student with current alternate text format accommodation assigned for the current term my textbook is being converted into an alternative text format (e-text, braille, audio format).
I understand that ACCESS does not supply textbooks, and I am responsible to submit a receipt or proof of purchase at the time of alternative text format request or my request will not be processed.
I understand that any electronic text, which may be supplied to me, is solely for my own educational purposes. I will not copy or distribute any such electronic 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 ACCESS services.
I understand that a violation of that policy, including improper distribution of electronic text, may result in the suspension of ACCESS services. Alternative text can take up to ten (10) business days to obtain, and Kurzweil conversations may take up to three days longer.
I understand that there is a possibility that my textbook may not be available in the alternate format requested. If this is the case, then I will need to allow for my textbook to be disassembled in order for ACCESS to scan and create the format needed.

Student ID B-

As an ACCESS student I have met with my ACCESS Counselor and have alternative text format accommodation for the current term.

Phone

Book Title/Edition

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	Enter the book title/edition (Click on the + or - buttons to add or remove books	Is this book offered to you free online?	Item weight

Semester

Term

Year

ACCESS does not supply textbooks, all receipt or proof of purchase must be submitted before any alternate text requests will be processed. If a receipt or proof of purchase is not submitted, the alternative text request is incomplete. Please contact ACCESS with any questions regarding proof of purchase.

Receipt Upload

One file only.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Requested Format (Check all that apply)

PDF

Braille

Audio

Converted to Kurzweil

Bookshare

For any questions or concerns regarding alternate text format requests, please contact ACCESS directly at: 760-252-2411 ext: 7225 or by email at ACCESS@barstow.edu

Main Campus

Fort Irwin Campus