Illinois Assistive Technology Program

Alternative Format Request SystemBarnabas Helmy2020-10-20T11:30:23-05:00

Request for Alternative Format Textbook

Complete the following for the person requesting the Alternative Format Textbook (District Staff ONLY may be Requestor)

Requestor Name

Requestor Phone

Requestor Email

County

School District

Complete this Section for the Student who will Receive the Textbook

Student Name (Required) *

Age (years)

Date of Birth

Sex

Dropdown

Text