Text Conversion Request Form

The following form is to be utilized by students approved for text conversion as indicated on their Student Academic Accommodation Request (SAAR) form. Students must have already completed/signed SAAR forms.

Students must provide ALL of the following information to ensure the correct textbook is converted and in a timely manner. Students will be loaned OCR text on CD for use with Kurzweil (or another text-to-speech tool).

* Required field

Student Information

Student Name *

Today's Date *

Year

Month

Day

Email *

Phone

Please indicate the format you are requesting *

Text Files

Kurzweil (kesi files)

Other Format

Please indicate the format you are requesting Other Format

Textbook Information

Course & section number *

Title of textbook *

Edition number/Year

ISBN (13 digits) *

Authors

Publisher

Additional textbook information

Course & section number

Title of textbook

Edition number/Year

ISBN (13 digits)

Authors

Publisher

Instructor information for the above book(s) requested

Instructor Name *

Phone *

Email *

Please indicate below which option you prefer *

Yes, I grant Iowa State University SDR staff permission to remove the binding from my textbook listed above. I understand that my text book will be returned to me rebound as a fully functional spiral bound textbook.

No, I do not grant Iowa State University SDR staff permission to remove the binding of my textbook listed above for the purpose of creating electronic text.

SDR will initially attempt to obtain a copy of the textbooks from the publisher, department and/or instructor. Please note that highlighted text, formulas, and/or pictures will not properly be read by the software. However, obtaining a usable and/or timely form of electronic text from the publisher may take 6-10 weeks.

Once submitted, a confirmation email will be sent to you. This email will contain information regarding our next steps.

CAPTCHA

This question is to prevent automated spam submissions.

Math question * 5 + 9 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

Dean of Students Office

Student Disability Resources