Alternative Media Request Form

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Before you complete this form, please make sure you meet the following qualifications:

  1. You have been approved for alternate media accommodations (such as digital textbooks for Kurzweil 3000).  
  2. You have either received your accommodation memo for this semester already or you are waiting for your accommodation memo to be processed. 
    • If you are waiting for your accommodation memo, please email your DRC counselor. They can let Alt Media know that you are in the process of receiving your memo, so we can start preparing your course materials.  

After you submit this form, you should hear back from us within three business days.  If you do not, please contact Donald Lariviere via email (lariviered@smccd.edu).

If you need help completing this form, please contact us via email (canadadrc@smccd.edu) or call 650-306-3259.


Name:*

Accommodation Memo for this semester*
Please select your Alternate Media accommodation(s).*
If you are asking Alt Media to upload your textbooks to Kurzweil, please tell us how you obtained your textbook(s).
Please upload your receipt or proof of purchase/rental here.
No File Chosen
File uploads may not work on some mobile devices.
If you are experiencing technical difficulties, please email Donald Lariviere at lariviered@smccd.edu for assistance.
If you are asking Alt Media to upload your textbooks to Kurzweil, upload your class schedule here. (You can get a copy of your classes on your Websmart).
No File Chosen
File uploads may not work on some mobile devices.
If you are experiencing technical difficulties, please email Donald Lariviere at lariviered@smccd.edu for assistance.

Alternate Media Needed for These Classes

You may not need Alternate Media for all of your classes. In this section, please list the classes where you need any of the following:

  • Textbooks uploaded into Kurzweil 3000
  • Converting text into accessible PDF/Word
  • Enlarged text materials
  • Tactile materials

The following statements describe our Alternate Media policies. Please read and agree to each one, then sign this form. 

I am a student of Cañada College and I am currently enrolled in classes.*
I understand that I must request Alternate Media Services each semester, and that this request form is only applicable for the semester indicated on this form.*
I understand that I must provide proof of purchase or rental for any material that I requested (for example, a receipt or email from an online store.)*
I understand that, except for digital files to be uploaded into my Kurzweil account, Alternate Media materials may be delivered to me via an electronic delivery service, such as TransferBigFiles.com. I agree to pick up any such material(s) in a timely manner.*
I understand that if the Alternate Media specialist cannot access a digital version of my textbook, then I will provide my purchased textbook to be cut, scanned, and rebound using comb binding.*
I understand that any electronic text supplied to me is solely for my own educational purposes. I will not copy or distribute any such electronic text in violation of the Copyright Revisions Act of 1976, as amended (17 U.S.C. Section 101 et seq.). I understand that failure to abide by this agreement may constitute a violation of the Student Code of Conduct, and/or of the college policy regarding responsible use of DRC services.*
By submitting this Alt Media request, I acknowledge the following: I understand that any electronic text, which may be supplied to me, is solely for my own educational purposes. I will not copy or distribute any such electronic text in violation of the Copyright Revision Act of 1976. I understand improper distribution of electronic text may constitute a violation of the Student Code of Conduct, and/or of the college policy regarding responsible use of DRC services. Violation of this agreement may result in a suspension of DRC services.*
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