Return the completed form to Disability Services, 155 University Centre or Fax to: 204-261-7732. Date received: __________
ALTERNATE FORMAT TEXTBOOK REQUEST FORM
Student Name _______________________________________________ Student Number _____________________________________________ Example: Telephone __________________________________________________ Intro to Psychology PSYC 1200 A01 Email _____________________________________________________ Best time/way to contact ______________________________________ Fall 2009 Winter 2010 Tammy Ivanco __________________________________________________________ Psychology & Life Gerrig Format of Textbooks 978013212699, 1st Ed. Audio (CD, cassette) E-text (pdf file) Pearson Education Canada Large Print Whatever I can get! Additional Comments _____________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ _______________________________________________________________________________________________
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Course Number ____________________________________ Course Number ____________________________________ Term Fall 2009 Winter 2010 Term Fall 2009 Winter 2010 Professor _________________________________________ Professor _________________________________________ Book Title ________________________________________ Book Title ________________________________________ Author ___________________________________________ Author ___________________________________________ ISBN, Edition _____________________________________ ISBN, Edition _____________________________________ Publisher _________________________________________ Publisher _________________________________________
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