Disability Services
Date of Request*
Student Name (First, Last)*
Bethel PO Box
Address (street, apt #)*
City*
State*
ZIP Code*
Phone Number*
E-mail address*
Course Name
Course Number
Instructor Name
Date Class Begins*
Date Book Is Needed
Book Title*
ISBN #
Author*
Publisher
Copyright Date/Edition
If not using the entire book, specify chapters/pages needed
When conversion of the book to an alternate format is completed, you will be notified by e-mail with instructions on how to access the book, unless other arrangements have been made through the Disability Services Office.
Questions? Call Deb Cupryna 651-638-6833, or e-mail <disability-services@bethel.edu>
