Request Form for Alternative-Format Textbook
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Select Your Program (if applicable)
If other, please enter your progam:
A copy of your textbook receipt must be scanned and attached or mailed or faxed to ESDS.
Upload a copy of your receipt.
Other Option: I will mail or fax my receipt
I will mail or fax my receipt
Please list the full name of the book, edition, ISBN #, author and publisher.
I Agree to the Following:
1) I have purchased the textbook indicated above and attached a copy of the receipt.
2) I have a disability that prevents me from using the textbook purchased.
3) I will not copy or further distribute the electronic files or other alternatives format of this textbook for any other purpose.
4) I agree to abide by the Copyright Law of the United States of America, as amended (17 U.S.C. Sec. 101 et seq.) and the applicable code of conduct of the University of Maryland.
5) I agree not to use, sell, transmit, publish, broadcast or otherwise disseminate any version of this textbook which has been modified for accessibility purposes, to anyone without the prior written permission of the Publisher.
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