Cornell Student Disability Services

Alternate Format/E-Text Request Form

This online form is for students who are currently enrolled at Cornell University and are registered with Student Disability Services. If you have not signed up for alternate format text service, STOP! All students must schedule an initial visit to our office to be enrolled in this service.

Please allow 15 business days to receive E-Text for published material and 5 business days for all other material. If the material you need converted to an alternate format is in an electronic form, you can email it to alternatemedia@cornell.edu. You must fill out the form below and indicate your request is for electronic material. Please Note: When bringing or emailing material to the office, please include your NET ID.

Only One Title Per Form

Student Information

Cornell NetID

(e.g., WQ386)

Full Name

Course Information - complete fully for first request for each course, then just enter course number for additional requests for same course

Semester

Course Number

(e.g., Psych 101)

Lecture, Section or Lab?

Lec/Sec/Lab Number

Instructor Name

Material Requested

Type of Material

Title

Author

ISBN (important)

Edition

Purchase Price

Sections Needed

Format Desired

Include Screen Reader

Optional Note or Additional Information:

By submitting this form, you agree to the following conditions:

You are registered with Student Disability Services and have been approved for an alternate format accommodation
You are registered this course for the current (or upcoming) semester at Cornell University
You have purchased or own the required material you are requesting here in alternate format
You have signed and will adhere to the Electronic Text Distribution Agreement