Accessible Format Request Form Note: If you have other accessible format requests you will have to fill in this form for each one separately. Mandatory fields marked with * This service is only available to students who are registered with Academic Accommodation Support. Are you registered with Academic Accommodation Support? * Yes, I am registered with Academic Accommodation Support Remaining Required Information * Please enter the first and last name of your Facilitator: * Your First Name: * Your Last Name: * E-Mail Address: * Desired File Format: -- Please select -- e-text Word e-text PDF Braille grade 1 Braille grade 2 Which Software will you be using it with?: * Course Code: * Course Section: * Course instructor's name: Do you know the specific title(s) of textbook(s) or reading(s) you need? Yes, I have these details. No, I do not have these details. * Title: * Author: ISBN: * Copyright or publication year (YYYY): + Add another reading for this course. + Add readings for a different course. I acknowledge that I own a printed copy of the textbook, and that I am registered in the class the textbook is to be adapted for use in. I also acknowledge that I am aware that production of my material may not begin until I bring my printed copy of the text or proof of purchase to the Library's circulation desk, to the attention of Kraigen Brown. * You have read and agree to the above terms. Please prove you are human and answer the question below. * If you write 4 directly next to 1 on a paper, what number did you write?