• I agree that I am enrolled for the semester at SUNY Fredonia and the particular course(s) for which I am requesting alternatively formatted instructional materials.
• I have provided the Coordinator of Disability Support Services for Students (DSS) with appropriate documentation of the disability that prevents me from using standard instructional material. I understand that this documentation will be kept on file at the college.
• I understand that I must purchase instructional materials at the same cost as other students.
• I agree that I will not copy or reproduce alternatively formatted instructional materials nor allow anyone else to do so pursuant to the requirements of the copyright revision act of 1976 as amended (17 U.S.C. §101 et seq.).
• I will not share alternatively formatted materials with any other party.
• I understand that any violation of this agreement may be considered a violation of the college’s Student Code of Conduct and may result in penalties including suspension and expulsion. Violations may also constitute a violation of federal and/or state laws and may result in civil or criminal prosecution, payment of fines or other moneys to the copyright holder, and/or incarceration.
Before receipt of materials, this agreement shall be signed by the student and the designated college official and kept on file each semester in which the student requests alternatively formatted materials.
I have read and understand the policies and procedures outlined above and agree to comply with them.
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Signature of Student Date
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Signature of SUNY Fredonia DSS Representative
Read to Student prior to signing by ____________________________________________
Signature