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Alternate Media Request Form

Hard copies of your proof of purchase (if applicable) and syllabus must be submitted to the Access Office for processing. Please turn these in as soon as possible to expedite your accommodation process.

Student Information

First Name Last Name

Student ID

VSU Email

Contact Number

Material Information

Course Abbreviation & Number (ex: ENGL 1101)

Title/Description of Material

Author

Copyright Year       Edition

Publisher

ISBN

Format Required    

Professor

Purchase price of book (Receipt must be submitted to Access Office before materials can be picked up.)

Book Condition

Date Needed: Month Date Year

Semester Year

Again, this process cannot be finalized without your receipt and syllabus. Please submit these as soon as possible. Any questions, please contact Mike McKinley at 229.245.2498 or email: mmckinle@valdosta.edu.

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