Alternate Format Request Form (Queen Elizabeth II Library)

This form is for students currently registered with the Glenn Roy Blundon Centre for Students with Disabilities. One completed form must be submitted for each requested item, and filling out this form will initiate a request. Turnaround time is on an item-by-item basis; due to this, students are encouraged to submit a request as soon as the item information is known.

Your Information

Library:

Name (last name, first name):  

MUN email:  

Phone Number:  

Course Information  

 

Semester:  

Course:  

Section:  

Instructor:  

Requested Item

If requesting a textbook, the Memorial University Bookstore offers a convenient look-up feature that can be used to identify the title and author of textbooks. This information can be copied and pasted into the relevant fields below. Students are also encouraged to consult their course syllabus for any changes.

Book Title:  

Author:  

Edition:  

Publisher:  

Publication Date:  

ISBN:  

Preferred alternate format, if available (e.g. audio book, electronic text):

Additional Information (e.g., if your course is using specific chapters, short stories, or poems within this item, provide the author(s), title(s) and page number(s):

Your request will be investigated by a librarian at the Queen Elizabeth II Library. They will follow up with you within 1-2 business days. For library-related inquiries, why not Ask a Librarian? For accessibility issues, please consult the Blundon Centre through their contact options.

The personal information collected on this form is used to administer and provide library services. Personal information is collected under the authority of the Memorial University Act (RSNL 1990 Chapter M-7). If you have any questions about the collection and use of this information, please contact the University Librarian at (709) 864-7428.

By completing and submitting this form, you consent to this collection of your personal information for the purpose outlined above.

   

August 10, 2010