Grant MacEwan University (MacEwan) agrees, subject to the terms set forth below and in accordance with applicable laws, to use reasonable efforts to assist the following student (the “Student”) in obtaining an alternate format of the following textbook or printed instructional material in accordance with the terms set out below.

1. The Student makes the following representations to MacEwan:

   1. The Student has purchased the standard printed version of the instructional material;
   2. The Student has a perceptual disability that prevents him or her from using the standard printed version of the instructional material; and
   3. The printed instructional material is required for a course in which the Student is registered at MacEwan.
      
      
2. The Student acknowledges and agrees that:

   1. Copyright in and all contents of the alternate format version of the printed instructional material remain the exclusive property of the publisher and any permission granted for use will not constitute a transfer of any rights or ownership;
   2. The alternate format of the printed instructional material will be made available to the Student on a one-time only, non-exclusive basis;
   3. The alternate format of the printed instructional material will be made available solely for the Student’s own educational purposes in connection with the Student’s studies and preparation related to the class for which the alternate format of the printed instructional material is obtained;
   4. The Student shall not share the alternate format of the printed instructional material with any other person whatsoever, including other students in the class;
   5. The Student shall not use, copy, disseminate, modify, distribute, sublicense, sell, rent, lease, lend, give or otherwise transfer the alternate format of the printed instructional material to any person for any purpose whatsoever

    

   SSD Office Use Only Alternate format obtained pursuant to the following authority:
   Publisher permission	Section 32 Copyright Act

    

   Protection of Privacy - This personal information requested on this form is collected and protected under the authority of the Alberta Post-Secondary Learning Act (s.65) and the Alberta Freedom of Information and Protection of Privacy Act (part 2).  It will be used for the purpose of confirming and managing students' disability related access to alternate format materials coordinated by Services to Students with Disabilities (SSD).  This form will be placed on file in the office that manages alternate format production and later stored in the student's SSD file.  Questions concerning the collection, use, and disposal of this information should be directed to:  Chair, Services to Students with Disabilities, Grant MacEwan University, 119A 10700-104 Avenue, Edmonton AB T5J4S2