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Alternative Media Request Form

Alternative Media is produced for Cerritos College Students, Faculty, and Staff with a verified disability. Items to be converted for a Student must belong to the Student and be needed for a Cerritos College course in which they are enrolled. Validation of a request may take two to three working days.

Which type of Alternate Media would you like to request?  Specify E-text format.

  E-Text & Format Braille Large Print MP3 Scan Check

Please enter the necessary information in the fields below:

  • Course Number, Section Number  and Instructor for which the work is required  

  • Indicate the Title, Edition, 13 and/or 10 digit ISBN of the work to be converted

  • The names of the book's author and  publisher

  • The semester required

Student Name Student Number
Course Number Section Number
Instructor
Title and Edition
ISBN Number 13 digit 10 digit
Author
Publisher
Semester

          If you have any other information pertinent to the conversion of this work such as a date required or that this is an update to a previously converted work please comment below..

Please, let us know how to get in touch with you:

Name
E-mail
Telephone (xxx)xxx-xxxx    
Please contact me as soon as possible regarding this matter.