Braille Transcription Order Form

Important Information

Handwritten materials will NOT be accepted.

If there is a syllabus associated with this request, please attach it to an email and send to braille.library@state.mn.us along with this completed form. If NO syllabus is provided materials will be completed upon availability of the transcriber. Materials submitted with a syllabus have first priority.

Standard Textbook (New Transcription) may require more than one full calendar year. Volumes are sent as completed. (Average of one volume per month.)

Two print copies are required. One copy needs to be an original and any photocopied materials need to be bound with a binder or secure clips (no paper clips or rubber bands). Original print materials will be returned to TBVI.

Please contact staff immediately by phone 651-539-2310 or email braille.library@state.mn.us with any CHANGES to the following request (i.e., client moved or no longer taking class, etc.).

Client Information

(*Required Information)

*Persistent Pseudonym (Unique Identifier)

*Grade Level

*Name of School

*School District Number

* Check one (Please specify contracted or uncontracted braille.)
Contracted Uncontracted

Special Instructions (i.e., double-spaced, single-side, no interpoint, etc.)

Material Section

Title

Author(s)

Publisher

Edition

ISBN 10

ISBN 13

Number of Copies

Syllabus (i.e., Class Calendar, Class Schedule, Assignment Due Dates, Information Regarding Type of Class, Honors, Accelerated, Semester Only, etc.)

Specific Dates for Use

(*Required Information)

*Class Start Date

*Class End Date

Mailing Information

(*Required Information)

Completed Braille materials will be mailed to contact name and address listed in this section.

*Name of School/Building/Business

*Contact Name

*Contact Phone

*Address

*City

*State

*ZIP Code

TBVI Information

(*Required Information)

*TBVI Name

*TBVI Phone

*TBVI Mailing Address

*TBVI City

*TBVI State

*TBVI ZIP Code

TBVI Email

TBVI Phone (Summer)

TBVI Email (Summer)

Order Authorization

(*Required Information)

*Ordered by

*Phone

I am a: Parent Resident of Minnesota TBVI