Colorado Instructional Materials Center (CIMC) 1015 East High Street, Colorado Springs, Colorado,80903 Phone: 719-578-2196 Fax: 719-578-2207 Book Order Form E-Mail Form To: cimcbookorders@csdb.org Date Order Submitted (due by April 1 annually for the following school year): Administrative Unit: If BOCES, name of Student’s District of Attendance: Student Name: Grade Level of Student during the 2020-2021 school year: Grade Level of the textbook on this order: AU Contact: Phone number for AU Contact: TVI: Phone number for TVI: *I, (enter the name of the person submitting this order here: ),have read the current CIMC UEB transition plan posted on the CIMC webpage and understand that NOT all materials will be delivered in UEB format. *Initial here: *If this form is not initialed, this order will be rejected. Book Title: Copyright date: Publisher: Is this a workbook, Yes or No? For more information regarding the CIMC policy regarding workbooks please refer to our website. *Book orders are not considered submitted "complete" until: 1. A confirmation email from cimcbookorders@csdb.org is received. 2. The ink print version of the textbook is received by the CIMC, if requested. Enter the ISBN(s) Numbers below for both the 13-digit and the 10-digit ISBN numbers. Include the hyphens: 13 DIGIT : 10 DIGIT : Sometimes a book has been printed by multiple publishing houses. They will have the same content but with different ISBN numbers. ISBN numbers are also different when one publisher produces one title in paperback vs. hardcover. If the ISBN you are requesting is not available, is an alternate ISBN number or copyright date acceptable, Yes or No? Media:Five media options are listed below. Please type the letter x before the undescore of the format option you are choosing: _Braille: English Braille American Edition (EBAE) format or Unified English Braille (UEB) format, whichever is available _Braille: EBAE format only. _Braille: UEB format only. (By checking this box the Administrative Unit is aware that if the CIMC cannot acquire this format the Administrative Unit will be responsible for producing the book), for more information regarding UEB implementation please refer to our website. IMPORTANT: If this is a UEB MATH request contact the CIMC immediately before sourcing begins by the CIMC staff. Multiple vendors are available to produce UEB with Nemeth. Very few vendors are available to produce UEB Math. It is important you contact the CIMC before sourcing begins if this is a UEB Math request. _APH digital large print file (IF AVAILABLE) Not all large print titles are available as a digital file. _Hard Copy Large Print School year: 2020-2021, or 2021-2022, or other: (please specify) For use: All year, 1st Semester only, or 2nd Semester only: Actual Date Needed: (Please do not write ASAP) Additional Information from AU: Revised March 2019