Course Reader Requisition Form

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Course Reader
Requisition Form
Instructor Information
308 Westwood Plaza
Ackerman Union A237
phone 310.825.2831
fax 310.825.2276
[email protected]
Reader Information
Instructor: Date in: Coordinator: Course dept. & number: Delivery address : Reg.# (UCLA Extension only): Email: Publication Title: Work phone: Quarter/Year : Expected enrollment: Desk copies: Last qtr./yr used: Library copy: Reproduction Instructions
Print Only
Electronic Only *
Binding Info
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Print & Electronic*
*Subject to availability, availability depends on content
rightsholder(s)
Tape bind
Spiral
Binder
3 hole/shrink wrap
Printing
Single-sided
Double-sided
Custom Cover
Add page numbers
Color Inserts
Tab Dividers
Subset staple
Table of Contents (TOC)
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TOC provided, input page numbers
Supplied with page numbers already
Copyright needed
Provide Estimate?
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Yes
Prof. royalty $: ■
Yes
No
Special Requests
OFFICE USE
Create TOC
Copyright Clearance
Date due: No
Yes
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Received by: REQ #: Copyright entered by: Date: RC made by: Date: Proofed by: Date: Data Entry (Date): ISBN#: No
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New
RC
Rev
Book Report
REPRODUCTION OF COPYRIGHTED MATERIALS: Infringement of copyright is a violation of civil law and may result in the imposition of penalties and damages exceeding
$50,000 or even criminal prosecution. The person authorizing this Work Order, whose signature is herto affixed, herby represents that the requested copying of materials
and their use shall be in compliance with UCLA Policy 1160, Reproduction of Copyrighted Materials for Teaching and Research. See complete definition of UCLA Policies 960
and 1160 in the 1986 UCLA Policy manual.
I hereby authorize this work order and request that processing of this order be in compliance with UCLA Policies 960 and 1160
rev. 05/12
Signature: I would like to receive emails and communications from
UCLA Academic Publishing Services
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