Mt. San Jacinto College

MSJC DSPS Alternate Media Request Form

Please fill out the form and click submit. Required fields are marked*.

When alternate formats are ready to be picked up in DSPS (Menifee or San Jacinto), DSPS will notify students by e-mail (MSJC student e-mail accounts). The materials will be available at the campus indicated below. Students will need to bring in a flash drive that is large enough to hold the electronic files (if applicable).

Select the DSP&S office where you would like to pick up your Alternate Media material in the Campus section at the bottom of the form.

*Student Name:

*MSJC Student ID:

*E-mail:
Student Email ends with @student.msjc.edu

Phone:

Course Number:

Section Number:

Title of Book/Item:

*ISBN:

Edition Number:

Author's Last Name:

Author's First Name:

Publisher Name:

Please select the type of Alternate Media you are requesting.

A copy of the textbook must be presented to DSP&S by the student at the time of picking up your materials. This is to verify studentís ownership of the textbook they are requesting DSP&S to adapt. By signing below I affirm that I own the textbook that I am requesting DSP&S to adapt into Alternate Media. If you do not present us with a copy of the book, we will not give you the materials requested.

I understand that it may take up to four weeks to receive alternate media materials. I also understand that some materials are not available from outside sources, and I may be asked to provide my book to be cut and scanned in order to facilitate this request.

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*Campus:

Message: