Student Participation Agreement
Note: This form is to be reviewed and signed by the student in the presence of his/her disability service provider. Student must initial where indicated. A signed copy of Part II of this form must be on file with AMAC before submitting an order for book in alternative formats.
The Alternative Media Access Center (AMAC), an initiative of the University System of Georgia, is committed to removing barriers and providing access to knowledge for individuals with physical, sensory, and learning print-related disabilities.
How AMAC Works
AMAC partners with your educational institution and acts as a conduit through which the institution provides textbooks in a variety of alternative formats.
- The student is responsible for identifying and registering for classes as soon as possible. Once the class has been selected, the student is responsible for obtaining the required reading list, purchasing the texts and providing that information to the Disability Service Provider (“hereinafter, DSP.”)
- The DSP then contacts AMAC and orders the required texts.
- AMAC provides the text in the student’s preferred alternative format. However, if the text is not available in that format, then AMAC will provide the next available format.
- Once the text has been converted, if it is in an electronic format, it is posted online to the student's account within the AMAC Student Center. The file will be available to the student for the remainder of the current semester.
- AMAC will notify the recipient of the file transfer using the primary email address on file for the recipient.
- If the material is available on CD, it is transferred to the DSP’s office or mailed directly to the recipient using the most current mailing address on file.
Finally, AMAC provides a myriad of hardware and software to assist recipients of its services in accessing text in a variety of alternative formats. Some of these tools may be unfamiliar to you. AMAC has a toll free help line to assist you in using the hardware and software that we provide. You may contact the Technical Support line at 1-866-418-2750 to obtain assistance.
Agreement
I, (student’s legal name), understand that I am eligible to receive an accommodation of books in alternative formats through the University System of Georgia Alternative Media Access Center. I also understand that to maintain my eligibility, I must adhere to all of the policies and procedures set forth by the Alternative Media Access Center (“hereinafter, AMAC”) for recipients of books in alternative formats. I therefore agree to:
___________ student initials |
|
___________ student initials |
|
___________ student initials |
|
___________ student initials |
|
___________ student initials |
|
___________ student initials |
|
___________ student initials |
|
___________ student initials |
|
___________ student initials |
|
___________ student initials |
|
Privacy Agreement
At AMAC, your privacy is our chief concern. We understand that you entrust us with your private medical and/or educational information to help us support you with accommodations.
In exchange for your trust, you expect and deserve our commitment to treat your information with respect. Rest assured that we will protect your privacy. Under no circumstances will AMAC share any personal information about you to or with any person or organization except as authorized by you, to professionals or other parties involved in your transaction.
We want you to be aware of who we are and how AMAC will serve you.
Information we may collect on the AMAC website includes your disability type, accommodation needs, and contact information for training support purposes;
Your information is used to develop an accommodation profile you will be able to access in a secure online environment. Only electronic materials, accommodation information, and strategies and solutions will be posted on the profile site.
Please review the information on our website to ensure that our services meet your needs.
I grant permission to my Disability Service Office and the Alternative Media Access Center to electronically share information noted on the Participation Agreement and the Materials Request forms between the two agencies.
( ) student initial
I am aware that information will not be given or transmitted to anyone other than AMAC and the Disability Services Office at which I am currently enrolled per the AMAC Participation Application date.
( ) student initial
I am aware that by agreeing to participate in AMAC services I may be contacted by AMAC production personnel for training and technical assistance.
( ) student initial
I am aware that as a result of receiving AMAC services I could be invited to participate in research pertaining to my disability and accommodations, and that I will have the right to refuse participation if I so choose.
( ) student initial
Instructions and Signatures
By signing this form, you, and your DSP, are affirming that you have documentation on file of the student’s disability, as well as copies of receipts for all requested texts.
Please print and sign this form. Be sure to make a copy for your records. Fax or mail signed forms to AMAC, USG/UGA, 272 West Hancock Avenue, Suite 200, Athens, Georgia 30602-5151 or fax to 706-369-5751.
By signing this form you, the student, are affirming that you have read (or have had read to you) this form, and that you understand and accept the guidelines set forth herein.
Student Signature_______________________________
Date______________________
DSP Signature_______________________________
Date_____________________
Name of Institution: (Name of Institution)