Request for Modified Textbooks

REQUEST FOR MODIFIED TEXTBOOKS

REQUEST FOR CD REQUEST FOR BRAILLE REQUEST FOR LARGE PRINT

Please prepare this form for each student needing CD’s, Braille, or Large print textbooks. Please separate your request by CD’s, Braille or Large print. THE NEED FOR MODIFIED TEXTBOOKS MUST BE DOCUMENTED IN THE IEP FOR ANY SPECIAL EDUCATION STUDENT OR ON THE 504 PLAN FOR ANY OTHER STUDENT. This form must be completed and given to the textbook coordinator at your school. The textbook coordinator should forward your request to the Purchasing Department for processing.

STUDENT’S NAME: ______SCHOOL ______TEACHER’S NAME: ______IEP FORM:______504 PLAN: ______

TEXTBOOK TITLE BOOKCODE ISBN NUMBER CD BRAILLE LG PRINT

PRINCIPAL’S SIGNATURE: ______DATE OF REQUEST: ______

ALL CD’s MUST BE RETURNED TO PURCHASING NO LATER THAN MID JUNE. ALL BRAILLE AND LARGE PRINT TEXTBOOKS MUST BE RETURNED TO PURCHASING NO LATER THAN MID JUNE . This is very important because when requesting modified text for next year we take what is on hand into consideration when preparing our order.