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Alternate Media and Additional Materials Request

  1. I am aware that I must complete one Additional Materials Request form per class.
  2. It is My responsibility to inform SSD immediately if there are any changes in my class schedule that will affect my request for alternate media.
  3. It is My responsibility to submit any materials requested as quickly as possible to SSD in order to expedite the production of my alternate media.
  4. It is My responsibility to check my campus email regularly for communications regarding the status of my alternate media.
  5. I am aware that this request form is only for additional materials, such as syllabi, course packets, course handouts, Power Points, and other materials not available from the Coyote Bookstore.
Student Information
Courses You Would Like Alternate Media For
Course 1 Information
Type of Material 1
Type of Material 2
Type of Material 3
Type of Material 4
Preferred Format
Course 2 Information
Type of Material 1
Type of Material 2
Type of Material 3
Type of Material 4
Preferred Format
Course 3 Information
Type of Material 1
Type of Material 2
Type of Material 3
Type of Material 4
Preferred Format
Course 4 Information
Type of Material 1
Type of Material 2
Type of Material 3
Type of Material 4
Preferred Format
Course 5 Information
Type of Material 1
Type of Material 2
Type of Material 3
Type of Material 4
Preferred Format