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Terms of Agreement

The New Jersey AltFormat Center operated by the Adaptive Technology Center works to ensure that accommodations are provided for students with documented, qualifying disabilities. In order to offer this service and comply with the law, the following policies and procedures apply to the use of alternate format material. Please read the statements below as you must agree to the following in order to have your request processed.

- I understand I must document a qualifying disability to my college's Disability Support Office and they will determine the eligibility of receiving AltFormat materials.

- I understand that I must have purchased and own a physical copy of all materials requested in AltFormat

- I understand I will provide a copy of the original hard copy material to the NJ AltFormat Center. The center will remove the binding of the book, separate the pages and comb-bind the book for return.

- I understand I must be registered and enrolled in the classes for which I am requesting the materials.

- Copying, sharing or redistributing materials from the NJ AltFormat Center in any form or to any person other than the individual making the request is prohibited by law and a violation of the publisher's rights.

- I understand that any violation of this agreement may be considered a violation of the Student Code of Conduct under my institution's policies and subject to penalties. Violations may also constitute a violation of federal and/or state laws and may result in civil or criminal persecution, payment of fines or monies to the copyright holderand/or incarceration.

I agree
I disagree

Your contact information.

First Name
Last Name
Email Address
Attending College/University
Campus Location

Your Campus Address & Phone Number (if you reside on campus).

Street
City
State, Zip Code
Phone Number

Your Home Address & Phone Number.

Street, Apartment #
City
Sate, Zip Code
Phone Number

What is your Student Status?

Full-Time
Part-Time
Other

What is your Credit Status?

Freshman
Sophomore
Junior
Senior
Super-Senior
Graduate

What is your Ethnicity?

White/Caucasion
Black/African-American
Hispanic/Latino
Asian
Native American
Other

What is your Gender?

Male
Female

What is your Primary Disability?

Deaf/Hard of Hearing
Blind/Visually Impaired
Learning Disability
Brain Injury
Physical/Motor
Multiple Disability
Other

Are you registered with the NJ Commission for the Blind?

Yes
No

What semester will you need the e-text?

Fall
Spring
Summer
Other

Provide the contact information for the Disability Support Coordinator at your College/University.

Name
Email
Phone

Book Request Information

Title
Author(s)
ISBN
Publisher
Edition/Year Published

Second Book Request Information

Title
Author(s)
ISBN
Publisher
Edition/Year Published

Third Book Request Information

Title
Author(s)
ISBN
Publisher
Edition/Year Published

Have you contacted the book's publisher to acquire the e-text needed?

Yes
No - You must check if the e-text version is available from the publisher before submitting this request.

Have you searched for the e-text version of the book on other databases, such as Bookshare, Gutenberg, NLS and RFB&D?

Yes
No - You must check other databases before submitting this request.

The Center needs considerable lead time to convert text. Actual production time varies depending on the demand for the Center's services as well as the book's length and subject matter.

Date Needed

What Software or Hardware will you be using to read e-text?

Software
Hardware

Which e-text format do you prefer?

Word (.doc)
PDF
Rich text Format (.rtf)

Do you require large print?

Yes
No

Will this book be brailled?

Yes
No

What is today's date?

Month/Date/Year