Course Pack Copyright Request - Book Chapter

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Personal Information
Request date
Name
Department
Phone/Extension
Email
Course Information
Course Name
Course Number
Semester of Course
No. of sections using course pack
Has the course pack been produced before?
If yes, when?
Book Information
Title of Book
Author(s) or Editor(s) of Book
Publisher(s)
Publication Date
Edition of Book
Title of chapter
Author of chapter
Page(s)
Does this constitute more than 10% of the book?
ISBN (if available)
Was this chapter originally published somewhere else?
If so, please provide us with the citation.
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