ࡱ> ] D&bjbjjj )b)b"  &&&&&:::8r,:P2OOOOOOO$RUP]&"P&&bP^&&OO01 `Prj71OxP0PK1VV(1V&10"3PP PV B :  ALTERNATE FORMAT AGREEMENT NAME: SEM/YEAR: STUDENT ID# PHONE # & By signing this agreement, Galveston College agrees to provide the following services: Evaluation for eligibility to use alternative formats of copyrighted materials. Provision of alternative formats of written materials (when available) throughout the period of continuous enrollment at 鶹ɫƬ. Learning Ally, Bookshare, publishers or other organizations may be utilized. Communicate with student when a request for alternate materials has been processed, and inform student when materials are ready to be picked up. By signing this agreement, I agree to the following conditions: & I must be registered with Galveston College Special Services Office and qualify to use alternative formats. & I must provide appropriate documentation that demonstrates my need for alternative formats of written materials. & I must show evidence that I am currently registered at Galveston College for the semester and particular course(s) for which I am requesting alternatively formatted materials. & Alternative formats of copyrighted texts will only be available during the semester for which I am registered in the course(s). & I will not revise, convert, disassemble, modify, sell, license, rent, loan or otherwise distribute the alternative format texts that I receive to any other person, institution or agency and will not allow anyone else to do so. & I must purchase either the printed or electronic version of the material and present proof of purchase to receive an alternate version. & I agree that I will pick up the alternatively formatted materials within 2 weeks of notification by the Special Se*<>@BJL^`n % ɾte[L@Lh<B*CJaJphh|hB*CJaJphhU*CJPJaJhU*CJOJPJQJaJo(h GB*CJaJph hXh5B*CJaJphhLg5B*CJaJphhU*5B*CJaJph h# h5B*CJaJphhhCJaJ h Gh Gh)t5CJaJh5hX5CJaJh55CJaJh5jhR_UmHnHu>@Bbd@ [ \ `gdU* & F `gd `^`gd `gdgd G$a$gd5gdU*gd5% 6 { } Z [ \    L  2^fz*024佮䑇ؑ{䑇hmiB*CJaJphhU*CJPJaJhU*CJOJPJQJaJo(hU*CJOJPJQJaJh|hU*B*CJaJphhhB*CJaJphhU*B*CJaJphhTLB*CJaJphh|hB*CJaJphhB*CJaJph0 .046  !v"x"z""" `gdU* `gd&U `*gd&U `gdTL `gdU* `gdU* `gd*0268: :Hn& "$bh佳佳̽󛙛佳h;W6B*CJaJphh"%B*CJaJphUh GB*CJaJphh&UB*CJaJphhU*CJPJaJhU*CJOJPJQJaJo(hTLB*CJaJphhU*B*CJaJphh|hB*CJaJphhB*CJaJph0rvices Office. & I will immediately notify Galveston College Special Services about any class or schedule change. & I agree that any violation of this agreement may result in service suspension until I meet with the Special Services Advisor. Repeated offenses may result in suspension of services until compliance can be assured. Galveston College Special Services Office and agree to the above conditions. (please print name) STUDENT SIGNATURE: DATE: GC REPRESENTATIVE S SIGNATURE: DATE:     Galveston College Counseling Department * 4015 Ave Q * Galveston * TX * 77550 * 409-944-1220 (phone) * 409-944-1501 (fax) Galveston College is an equal opportunity institution in education and employment. 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Segoe UI?= .Cx Courier New;WingdingsA$BCambria Math"qhPeG[ggf' . \\!x24   3QHP ?2!xx(X SPECIAL SERVICESGalveston College Jayne Withers(       Oh+'0  $0 P \ h tSPECIAL SERVICES鶹ɫƬNormalJayne Withers11Microsoft Office Word@ l@@W@j}P\ ՜.+,0 hp  鶹ɫƬ  SPECIAL SERVICES Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry FP@1Table>VWordDocument SummaryInformation(DocumentSummaryInformation8MsoDataStore `P `PXU0NEHPEYNKQ==2 `P `PItem PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q