ETSU Disability Services
Books on Tape Request

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SID Last First Middle Initial Semester

________________________________________________________ ____________________ Mailing Address Telephone

Student Responsibility Statement
I [circle one] (am registered for / will register for) the classes listed below. I have requested that Disability Services {DS} assist me in [circle one] (ordering / getting information concerning) books on tape for this semester. I understand that it is my responsibility to inform DS in writing of my planned schedule and to complete a Books on Tape Order Request Form every semester. I also understand that making changes in my schedule or failing to begin the books on tape process a minimum of eight weeks prior to the beginning of a semester may cause a delay in obtaining course materials.
It is ETSU’s policy to assist students with print disabilities with the Books on Tape ordering process. If I choose to order my own books on tape, I understand that it is my responsibility to notify DS immediately if a book is not available so DS can assist me in obtaining the materials locally. Once notified, DS will be responsible for a qualified reader to record the materials for me.

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Staff Student Date

1. Date ordered _____________ Shipped to [circle one]: Student’s address_____________ DS office__________
2. Date ordered _____________ Shipped to [circle one]: Student’s address_____________ DS office__________
3. Date ordered _____________ Shipped to [circle one]: Student’s address_____________ DS office__________
4. Date ordered _____________ Shipped to [circle one]: Student’s address_____________ DS office__________
5. Date ordered _____________ Shipped to [circle one]: Student’s address_____________ DS office__________

1. Student notified to pick up on ____________ Date tapes are picked up: ____________
2. Student notified to pick up on ____________ Date tapes are picked up: ____________
3. Student notified to pick up on ____________ Date tapes are picked up: ____________
4. Student notified to pick up on ____________ Date tapes are picked up: ____________
5. Student notified to pick up on ____________ Date tapes are picked up: ____________

For books not available on tape:
Date student notifies DS book is not available: _______________________________ (When student orders alone)

Reader’s name: ____________________________________________________ Telephone No. _____________

Comments:_________________________________________________________________________________

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