You must have JavaScript enabled to use this form. Drop/Replace Previously Submitted Alt Media Request 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. 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. It is My responsibility to check my campus email regularly for communications regarding the status of my alternate media. Student Information First Name Last Name Coyote ID CSUSB Email Phone Number Phone Type - Select -HomeWorkCell Term Information Request Term - Select -FallWinterSpringSummer - RegularSummer - 6W1Summer - 6W2 Request Year - Select -2017201820192020 Are you replacing or dropping a course previously submitted for this term? Replacing/Changing Dropping Dropping Courses Number of Courses Dropping 12345 Course Information 1 Course Name Section Number Class Number Course Information 2 Course Name Section Number Class Number Course Information 3 Course Name Section Number Class Number Course Information 4 Course Name Section Number Class Number Course Information 5 Course Name Section Number Class Number Replacing/Changing Courses Number of Courses 12345 Course 1 Information Old Course Information Course Professor Class # Section New Course Information Course Professor Class # Section Course 2 Information Old Course Information Course Professor Class # Section New Course Information Course Professor Class # Section Course 3 Information Old Course Information Course Professor Class # Section New Course Information Course Professor Class # Section Course 4 Information Old Course Information Course Professor Class # Section New Course Information Course Professor Class # Section Course 5 Information Old Course Information Course Professor Class # Section New Course Information Course Professor Class # Section Student Signature