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Alternative Textbook Request Form

I understand that I am required to purchase the textbook before I can borrow an alternative textbook. It is a violation of Federal Law and Disability Support Services policy for students to share, duplicate, upload or distribute alternative text media. I also understand that doing so may result in the loss of the alternative textbook accommodation and/or legal action.

If you would like all of your textbooks in the same format, there is no need to list the titles. If you would like them in different formats, please list the titles individually.

We will contact you when your textbooks are in.

If you have any questions about this form, please contact

Becky Allington at (616) 234-3597 or


Personal Information
First and Last Name
Your Student ID Number should contain 7 numbers.
Please use a current, working phone number.
Counseling Information
Please tell us the name of the counselor who referred you to this form
Course Information
If you have already purchased your textbooks, you can upload a copy of your receipt here. If you haven't, please be sure to bring either the textbooks or a copy of the receipt showing that you've purchased them when you come to pick them up.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png bmp tif txt pdf doc docx.
Requested Titles
If you are requesting a textbook that comes in a bundle, please indicate ISBN's separately. If you would only like certain textbooks in alternate format, indicate so here, otherwise we will provide all textbooks. You can also choose to have different textbooks in different fomat below.
This option only applies if you are receiving e-texts, not audio or large print textbooks. If you choose to have them uploaded to Blackboard, you will need to provide either a copy of the receipt or bring your textbooks to the office so we can see that you've purchased them.