BRAILLE ON DEMAND

BRAILLE ON DEMAND REQUEST FORM

Media Center/Arizona Instructional Resource Center

1235 E. Harmont Drive, Phoenix, AZ 85020

Phone: 602.678.5816 or 5810 – Fax: 602.678.5811

www.SeeItOurway.org

Please fill out one request form per document requested. In order to stay within a 48-hour turnaround, documents must be no more than 10 print pages. Requests for documents longer than 10 print pages will require more than 48 hours; turnaround time will be indicated. No portions of current district textbooks or books with ISBNs will be transcribed under Braille on Demand. All requests will receive confirmation of receipt.

Name of person filling out this request:	*
Today's Date	*
Date Braille Needed	*
Student Name	*
Grade	*
School District	*
School	*
Student's TVI	*
Phone	*
Email	*

Document Information
Title of Document	*
Subject	*
Grade Level	*
Number of physical print pages	*
Print pages numbered as	*

Production Preferences
Braille Format	*
Pagination	*
Line Spacing	*
Binding	*

Delivery Preference
Braille will be picked up by
Pickup Phone
Braille will be sent via email to
Braille will be mailed to (full address)
Is this is an hourly request?	*	Yes No
Is this a flat fee request?	*	Yes No
File Upload


PLEASE DO NOT COMPLETE THIS SECTION (FBC ONLY)
District PO#
Transcriber
Transcriber Email
Date Project sent out
Date Project completed
Final tally of Braille pages
Number of Billable hours
Total paid to Transcriber
Invoice number
Invoice date
Total billed for Project
Invoice number.
Invoice date.