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Request for Materials in an Alternate Format
I understand:
  1. The materials that I am submitting are directly related to the course(s) that I am enrolled in. The Student Success Center cannot convert materials for a personal use.
  2. I will use these materials for academic purposes only and I will not sell these items.
  3. I may be asked to return the materials to the Student Success Center when I am finished with them.
  4. All efforts will be made to convert materials quickly. I understand that it may take up to four weeks to get materials converted during busy times of the semester.

Full Name: 
Current Phone Number: 
Email Address: 
What do you need converted to an alternate format? (describe) 
When do you need these materials?  
To what format do you need the materials converted?
Please electronically sign this form with your SID
Student SID