Student Textbook/Educational Materials Request Form (for Print Disabled K-12 Students)

Please use this form to request materials for NIMAS and Chafee-Eligible blind, visually impaired, physically disabled, or reading disabled K-12 students who qualify under the Chafee provisions of the U. S. Copyright Law.

Materials can be ordered in the following formats:

• Braille
• Large Print
• Audio Cassette
• Learning Ally Audio
• Digital Audio
• Electronic Text

Formats available for electronic text include:

• Braille-Ready Format (BRF)
• Kurzweil 3000 format (KESI)
• Text-Based Daisy (*only an option if Nimas or Bookshare files are available)
• ePub (*only an option if Nimas or Bookshare files are available)

Please indicate your first and second preference for format for each item.

Student Information

Shipping Information

First Book/Material Information

Second Book/Material Information (if applicable)

Third Book/Material Information (if applicable)

Fourth Book/Material Information (if applicable)

Fifth Book/Material Information (if applicable)

Sixth Book/Material Information (if applicable)