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Request for Alternate Media Format Services

Contact Wendy Palmer if you have questions.

Portland Community College students who have been approved for Alternate Media Format Services may submit on-line requests to Disability Access Services (DAS). Students must use their secure MyPCC email account because they will be asked to accept the terms of service.

Students may be approved for this accommodation by submitting appropriate documentation to a disability services counselor located at Cascade, Rock Creek, and Sylvania campuses and the SE Center. Questions may be directed to Wendy Palmer, District Coordinator.

Request for Alternate Media

Your Information:

Your Name: PCC Email: Telephone:

Request:

For Term: Fall 2009 Winter 2010 Spring 2010 Summer 2010 Fall 2010 Winter 2011 Spring 2011 Summer 2011 Fall 2011 Winter 2012 Spring 2012 Summer 2012 Request: New (First time for these materials) Renewal of Current Order

Format Requested: Audio FormatPrint material is made available to be heard using specially-formatted. players (such as DAISY) or regular players (such MP3 or CD).
Electronic Format Print material is made available to be used on a computer using adaptive software. Enlarged Format Print material is enlarged an printed onto paper using an electronic file or a photocopy machine.

Course and Materials:

Course Title: Course Location: Instructor Name: If instructor is unknown, write "staff" Title of Material: Author(s): Edition: Copyright Year: Publishing Company: ISB Number:

Purchase Status: I have purchased this text (and will make a copy available to DAS). I have not purchased this text, but am planning to purchase it. I received this material from my instructor.

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