Please fill in a valid value for all required fields

Please ensure all values are in a proper format.

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

CU DENVER, DISABILITY RESOURCES & SERVICES (DRS) ELECTRONIC TEXTBOOK REQUEST FORM

This form is for students registered with DRS who receive the academic accommodation of 
textbooks in an electronic, accessible format.

 • Proof of purchase is required in order for accessible formats to be distributed.
 • An option to upload proof of purchase is at the end of this form. 
 • If you have questions about proof of purchase, email us.
 • Please complete this form to the best of your knowledge and click the Submit button. 
 • Your form will be submitted to a DRS staff member.

 [Fields marked with * are required.]

First Name*

Last Name*

Student ID*

CU Denver Email*

Confirm CU Denver Email *

Phone

Semester *

Fall Spring Maymester Summer

Academic Year*

Do you use any of the following? (check all that apply)

Kurzweil 3000 Universal Library Bookshare Learning Ally

Additional comments:

250 characters max

Textbooks Needed

How many text books do you need?*

Textbook 1 Information

Textbook Title *

ISBN *

10 or 13 digit number without dashes

Publisher*

Year *

Edition*

Enter "NA" if None

Course Number Requiring Textbook*

E.G., ANTH 1001

File Format Requested *

PDF E-PUB (E-book) Word Learning Ally Audiobook Braille

Other:

Textbook 2 Information

Textbook Title *

ISBN *

10 or 13 digit number without dashes

Publisher*

Year *

Edition*

Enter "NA" if None

Course Number Requiring Textbook*

E.G., ANTH 1001

File Format Requested *

PDF E-PUB (E-book) Word Learning Ally Audiobook Braille

Other:

Textbook 3 Information

Textbook Title *

ISBN *

10 or 13 digit number without dashes

Publisher*

Year *

Edition*

Enter "NA" if None

Course Number Requiring Textbook*

E.G., ANTH 1001

File Format Requested *

PDF E-PUB (E-book) Word Learning Ally Audiobook Braille

Other:

Textbook 4 Information

Textbook Title *

ISBN *

10 or 13 digit number without dashes

Publisher*

Year *

Edition*

Enter "NA" if None

Course Number Requiring Textbook*

E.G., ANTH 1001

File Format Requested *

PDF E-PUB (E-book) Word Learning Ally Audiobook Braille

Other:

Textbook 5 Information

Textbook Title *

ISBN *

10 or 13 digit number without dashes

Publisher*

Year *

Edition*

Enter "NA" if None

Course Number Requiring Textbook*

E.G., ANTH 1001

File Format Requested *

PDF E-PUB (E-book) Word Learning Ally Audiobook Braille

Other:

Textbook 6 Information

Textbook Title *

ISBN *

10 or 13 digit number without dashes

Publisher*

Year *

Edition*

Enter "NA" if None

Course Number Requiring Textbook*

E.G., ANTH 1001

File Format Requested *

PDF E-PUB (E-book) Word Learning Ally Audiobook Braille

Other:

Textbook 7 Information

Textbook Title *

ISBN *

10 or 13 digit number without dashes

Publisher*

Year *

Edition*

Enter "NA" if None

Course Number Requiring Textbook*

E.G., ANTH 1001

File Format Requested *

PDF E-PUB (E-book) Word Learning Ally Audiobook Braille

Other:

Textbook 8 Information

Textbook Title *

ISBN *

10 or 13 digit number without dashes

Publisher*

Year *

Edition*

Enter "NA" if None

Course Number Requiring Textbook*

E.G., ANTH 1001

File Format Requested *

PDF E-PUB (E-book) Word Learning Ally Audiobook Braille

Other:

Textbook 9 Information

Textbook Title *

ISBN *

10 or 13 digit number without dashes

Publisher*

Year *

Edition*

Enter "NA" if None

Course Number Requiring Textbook*

E.G., ANTH 1001

File Format Requested *

PDF E-PUB (E-book) Word Learning Ally Audiobook Braille

Other:

Textbook 10 Information

Textbook Title *

ISBN *

10 or 13 digit number without dashes

Publisher*

Year *

Edition*

Enter "NA" if None

Course Number Requiring Textbook*

E.G., ANTH 1001

File Format Requested *

PDF E-PUB (E-book) Word Learning Ally Audiobook Braille

Other:

Terms and Conditions

I understand that I will need to provide proof of purchase for my textbook requests before they are distributed to me (upload proof of purchase(s) below if available)
If necessary, I must also provide the purchased hardcopy book for unbinding/scanning.
I understand that DRS staff cannot cut and unbind rented textbooks.
I understand that if my preferred file format is not available, DRS staff will provide access to another accessible file format type.
I agree not to reproduce or distribute this e-text in any other format nor can anyone else be allowed to do so. Any further reproduction or distribution is considered copyright infringement.

By signing your name below, you understand these terms and conditions.*

First Name

Last Name

Proof of Purchase Upload

No File Chosen

File uploads may not work on some mobile devices.

Optional: provide proof of purchase either now or anytime before electronic textbook can be distributed