Course Reserve 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 Reserve Material
Has the item been on Reserve before?
Reserve Material Information
In what format would you like the reserve material to be?
Please check one:		 Print
Electronic
Both
Title of Book
Author(s) or Editor(s)
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)
Additonal Information
Was this material originally published somewhere else?
If so, please provide us with the citation:
Do you own a copy of this book?
Does the library own a copy of this book?
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