Electronic File Request for Students With Disabilities

If you are a student who has a verified disability that prevents you from using standard instructional materials,or if you are a school writing on behalf of the student, please fill out this request and agreement for the electronic file you require.

We will respond as quickly as possible, but please understand that it may take 2-3 weeks for you to receive the electronic file. Fields marked with a red asterisk (*) are required to fill out.

Thank you.
OUR PRODUCT INFORMATION:
Title: *
Edition: *
Author: *.
ISBN: *

YOUR ELECTRONIC FILE NEEDS INFORMATION:
Type of Electronic File:*
Need text extraction? Specify Program:
(i.e. Word, WordPerfect, ASCII)
Program Version:
(i.e. Word 97, WordPerfect 8) *
Platform:*

YOUR SCHOOL INFORMATION:
Name of School: *
School Address:*
City:*
State:*
Zip Code:*
Country:

COORDINATOR OF SERVICES OR OTHER SCHOOL OFFICIAL:
First Name:*
Last Name:*
Telephone Number:*
Fax Number:
Email Address:*
Instructor's Name: *
Course Name: *
Semester: *

STUDENT INFORMATION:
(If for reasons of confidentiality the school does not want to give the student's name, give your name instead)
First Name: *
Last Name: *

MAILING ADDRESS WHERE FILE SHOULD BE SENT:
First Name: *
Last Name: *
Address*
City:*
State:*
Zip Code:*
Country:

VERIFICATION AND AGREEMENT:

I verify and agree that:
a.    The requesting school or disabled student has purchased the above named printed work (the "Title").
b.    The student is registered to take or attend the above course requiring the use of the Title.
c.    The student has a disability that prevents him or her from using the Title.
d.    The request is made or supported by the Coordinator of Services for Students with Disabilities or other appropriate school official.
e.    The Title has been determined to be essential to the student's successful completion of the course.
f.    The student and the school will not use or further distribute or copy the electronic files for the Title for any other purpose.
g.    In using the electronic files provided by the Publisher, the disabled student, the College Disabled Student Services Office, or other student official, will abide by the Copyright Law of the United States of America, as amended (17 U.S.C. Sec 101 et seq.) and the applicable code of conduct and policy of the requestor's school.
h.    Pearson Education, Inc. owns all rights to the Title and the electronic files for the Title, including copyright. The student and the school have only the right to use the electronic files for the purposes set forth in this request.

OTHER INFORMATION:

CALIFORNIA STATE OR COMMUNITY COLLEGE STUDENTS AND STUDENTS ENROLLED IN ANY POSTSECONDARY INSTITUTIONS IN ARKANSAS OR TEXAS SHOULD NOTE THE FOLLOWING:
a) If the school participates in a multidistrict alternative media center, the request should come from the center.
b) California requestors must check that a master copy of this file is not already stored at the High Tech Center Training Unit (HTCTU) Book Exchange Website, which has been established to maintain an inventory of electronic text files received from publishers.
c) Texas requestors must check with their school's disability service provider to see if their school is a member of the Texas Text Exchange.

Please read the following statement. By checking the box, you have made the following agreement:

 I verify that the above answers and verifications are complete, true and correct and that by submitting this request and receiving the requested electronic file, I am agreeing to abide by these terms.

Requestor's Full Name:*
Title: (if any)
Comments: (Optional)

   

We welcome your feedback about our response to your request. Contact emily.mcgee@pearsoned.com with your comments.