* Title

* Edition

* Author

* ISBN

* Date of textbook purchase (mm/dd/yy)

 

* Location of textbook purchase (Enter at least one)

 

* Purchase Price Paid($)

* First Name

* Last Name

* Phone

Fax

* E-mail

* Instructor's Name

* Course Name

* Semester

* Are you making this request on behalf of a centralized repository, depository, or other file storing system?
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* Have you verified that the student or someone on his or her behalf has issued payment to the publisher equal to the cost of the print version of the textbook?
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UPON ELECTRONIC RECEIPT OF VALIDATION FROM PEARSON EDUCATION CANADA, INC., YOU ARE PERMITTED TO OBTAIN THE FILE FROM YOUR SCHOOL'S CENTRALIZED LOCATION, PROVIDED ALL CRITERIA ON THIS FORM HAVE BEEN MET.

* Name of School

* School Address

* City

* Province/State

* Postal Code/Zip Code

* Country

* Student's First Name

* Student's Last Name

I verify and agree that:

1. The requesting school or disabled student has purchased the above named printed work (the "Title").
2. The student is registered to take or attend the above course requiring the use of the Title.
3. The student has a disability that prevents him or her from using the Title.
4. The request is made or supported by the Coordinator of Services for Students with Disabilities or other appropriate school official.
5. The Title has been determined to be essential to the student's successful completion of the course.
6. The student and the school will not use or further distribute or copy the electronic files for the Title for any other purpose.
7. In using the electronic files provided by the Publisher, the disabled student, the College Disabled Student Services Office, or other student official, will abide by the Copyright Law of Canada and the applicable code of conduct and policy of the requestor's school.
8. Pearson Education Canada, Inc. owns all rights to the Title and the electronic files for the Title, including copyright. The student and the school have only the right to use the electronic files for the purposes set forth in this request.

This file is being provided for use by one student with a disability at your institution 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 organization, 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 Education Canada, Inc.

EXCHANGE OF THIS OR ANY OTHER FILE, IN A MODIFIED FORMAT OR COPY THEREOF, IS A VIOLATION OF THE CANADIAN COPYRIGHT ACT. SEPARATE AUTHORIZATION 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

Please read the following statement. By checking the box, you have made the following agreement:

* Requestor’s Full Name

Title (if any)

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