Deadlines for receipt of form by Bookstore:
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•
Fall/Summer Semester . . . . . . . . . . Feb. 21
BOOKSTORE
UNIVERSITY OF SOUTH ALABAMA
460-7011
Spring Semester . . . . . . . . . . . . . . Sept. 16
COURSE PACK REQUEST FORM
The faculty member is requested to meet with the Textbook Manager
in the Bookstore to discuss the best way to produce the material.
Semester__________________________
Department____________________
Course Pack Title_____________________________________
# of copies per original___________________
Used Before______________________
Faculty Name __________________
Course #____________
Section # ______________
Required_____________
Recommended_______________________
New______________________
Will be used again ____________ semester
Department Secretary______________________
Dept. telephone_______________
Dept. address ______________
Does the material have any copyrighted components? _____________________________________________________
(If copyrighted release has already been obtained, attach copy of release)
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3 hole drill
punch and bind
new addition attached
on file at bookstore
If material includes any copyrighted component(s), provide the information below for each copyrighted source
Source 1
ISBN/ISSN:
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■
Source 2
■
■
Signature(s)
Auth/Ed/Trans of Book: ___________________
_______________________________________________________________
Chapter/Article Name
_______________________________________________________________
Author of Article:
______________________
Copyright Year (2digits)
______ Pubn Yr (If differs):___________
■
_______________________
Total # of Pgs:_______ From:______ To: ______
■
Volume:______ Edition: ________
Auth/Ed/Trans of Book: ___________________
Publisher/Rightsholder:
_______________________________________________________________
Chapter/Article Name
_______________________________________________________________
Author of Article:
______________________
Copyright Year (2digits)
______ Pubn Yr (If differs):___________
ISBN/ISSN:
■
■
Publisher/Rightsholder:
ISBN/ISSN:
■
Source 3
_______________________
■
_______________________
Total # of Pgs:_______ From:______ To: ______
■
Volume:______ Edition: ________
Auth/Ed/Trans of Book: ___________________
Publisher/Rightsholder:
_______________________________________________________________
Chapter/Article Name
_______________________________________________________________
Author of Article:
______________________
Copyright Year (2digits)
______ Pubn Yr (If differs):___________
■
Total # of Pgs:_______ From:______ To: ______
Volume:______ Edition: ________
_________________________________________________
Faculty Member
____________________
Date
_________________________________________________
Chair
____________________
Date