Disability request form (Higher Education)
As an educational publisher we believe that resources should be available for the needs of all students and we endeavour to ensure students with specific requirements are not disadvantaged. It is our policy to provide electronic copies of our publications to students with specific learning requirements, provided they have met the Institution criteria for assistance and agree to the conditions of use as per below. If you are a student who has a verified disability that prevents you from using standard instructional materials, please have your Disabilities Service Coordinator or other Institution official fill out this request and agreement for the electronic file you require. We will respond as quickly as possible, but please understand that it may take 3-4 weeks to receive the electronic file.

Requests from students or parents/guardians are not accepted.

We ask that you supply one form per student, per title. This will assist us in processing the request quickly and simply.

TIP: go to the following link to find out how to set the auto-fill function on your browser for quicker submission: http://www.computerhope.com/issues/ch001377.htm

If your request is for a US Publication please click on the following link to go directly to the US Disability Request Form:
https://order.superlibrary.com/Comergent/en/US/adirect/pearson?cmd=DisabilityRequestForm.

If you need to check if the book is a US title please email us at copyright@pearson.com.au.

Section 1: Our Product Information
ISBN
Please note the ISBN of the product you wish to obtain
Your answer
Title
Please note the title of the product you wish to obtain
Your answer
Author
Please note the author of the product you wish to obtain
Your answer
Edition
Please note the edition number of the product you wish to obtain
Your answer
Has the textbook been purchased previously?
This information is required to ensure that the School or Institution has previously purchased the product and the customer is, hence, eligible for a disability edition
Date of textbook purchase
Please enter the date the original textbook was purchased (if available)
MM
/
DD
/
YYYY
Section 2: Coordinator of Services/Responsible School Official and Academic Information
First & Last Name
Please enter the name of the coordinating contact for disability requests
Your answer
Phone
Please enter the phone number of the coordinating contact identified above
Your answer
Email
Please enter the email address of the coordinating contact identified above
Your answer
Section 3: School Information
Name of School
Your answer
Address
Your answer
City
Your answer
State
Your answer
Postcode
Your answer
Section 4: Electronic File & Delivery
PDF: an AdobeĀ® Portable Document Format (PDF) file (only file format available). We can no longer supply Word format documents. We apologise for any inconvenience.
Preferred delivery of files
Required
Section 5: Attachments

Please forward any attachments to copyright@pearson.com.au with 'Disability Request', title and date in the subject matter.
Section 6: Agreement
It is a condition of the provision of these files that you verify and agree:
a. The student or school has purchased a printed copy of the title.
b. The student is registered at the School identified in this form
c. The student has a specific learning requirement that prevents them from using the printed Title.
d. The request is made and supported by the Equity & Diversity officer or other appropriate school official.
e. The student and the school will not use, further distribute or copy the electronic files for the Title for any other purpose.
f. In using the electronic files provided by the Publisher, the student, the school, the institution, or other student official will abide by Australian Copyright Law and the applicable code of conduct and policy of the requestor's Institution.
g. Pearson own all rights to the Title and the electronic files for the Title, including copyright. The student and the Institution have only the right to use the electronic files for the purposes set forth in this request.
h. Pearson will not be responsible for any damages arising out of the use of this software including loss of data, other software problems or personal injuries.

This file is being provided for use by one student with a disability at your institution or school who is the specific subject of this request. You agree not to otherwise reproduce, use, sell, transmit, publish, broadcast, or otherwise disseminate or distribute the file (or any version modified for accessibility purposes) to anyone, including but not limited to other students with a disability at your or any other institution, others in the same company, school, college or other organisation, whether or not for a charge or other consideration, including but not limited to use in connection with the sale, retransmission, distribution, publication, broadcasting, circulation or other dissemination, for any purpose, whether commercial or otherwise, without the express prior written permission of Pearson.

EXCHANGE OF THIS OR ANY OTHER FILE, IN A MODIFIED FORMAT OR COPY THEREOF, IS A VIOLATION OF THE COPYRIGHT ACT 1968. SEPARATE AUTHORISATION MUST BE OBTAINED FOR EVERY USER OF THIS FILE, ITS MODIFIED FORMAT OR COPY THEREOF, AND SEPARATE PROOF OF PURCHASE OF THE TEXT MUST BE PROVIDED.

I verify that the above answers and verifications are complete, true and correct and that by submitting this request and receiving the requested electronic file, I am agreeing to abide by these terms.
Requestor's name
Your answer
Requestor's email
Your answer
Comments
Your answer
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