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Alternate Format Book Request Form

Alternate Format Book Request Form


Students who have the approved accommodation of receiving their books in alternative formats should complete this form. It can take up to 2 weeks for our office to fulfill this request. It is imperative that the information provided is correct and submitted in a timely manner. With this form, you must also submit a receipt for the hard copy of the book as a proof of purchase. We cannot begin processing your requests for books without receipts. If you have any questions, please don't hesitate to contact the ACCESSibility Office at accessibility@mercy.edu .

General Information

Semester*
Year: *

Book Information #1

No File Chosen
File uploads may not work on some mobile devices.
Do you need to make a request for another book? *

Book Information #2

No File Chosen
File uploads may not work on some mobile devices.
It is permissible to upload the same receipt that you used for the previous book if the books are part of the same puchase.
Do you need to make a request for another book? *

Book Information #3

No File Chosen
File uploads may not work on some mobile devices.
It is permissible to upload the same receipt that you used for the previous book if the books are part of the same puchase.
Do you need to make a request for another book?*

Book Information #4

No File Chosen
File uploads may not work on some mobile devices.
It is permissible to upload the same receipt that you used for the previous book if the books are part of the same puchase.
Do you need to make a request for another book?*

Book Information #5

No File Chosen
File uploads may not work on some mobile devices.
It is permissible to upload the same receipt that you used for the previous book if the books are part of the same puchase.
Do you need to make a request for another book?*

Book Information #6

No File Chosen
File uploads may not work on some mobile devices.
It is permissible to upload the same receipt that you used for the previous book if the books are part of the same puchase.
Do you need to make a request for another book?*

Book Information #7

No File Chosen
File uploads may not work on some mobile devices.
It is permissible to upload the same receipt that you used for the previous book if the books are part of the same puchase.
Do you need to make a request for another book?*

Book Information #8

No File Chosen
File uploads may not work on some mobile devices.
It is permissible to upload the same receipt that you used for the previous book if the books are part of the same puchase.
Do you need to make a request for another book? *

Book Information #9

No File Chosen
File uploads may not work on some mobile devices.
It is permissible to upload the same receipt that you used for the previous book if the books are part of the same puchase.
Do you need to make a request for another book? - Copy*

Book Information #10

No File Chosen
File uploads may not work on some mobile devices.
It is permissible to upload the same receipt that you used for the previous book if the books are part of the same puchase.
Do you need to make a request for another book?*

Acknowledgement

*
Use your mouse or finger to draw your signature above
Date/Time