UNIVERSITY OF PITTSBURGH \ FORM INSTRUCTION GUIDE



FORM TITLE:              INSTRUCTIONAL MATERIALS ORDER FORM
NUMBER:                  FORM 0098
PROCEDURE:               05-05-01



    COMPLETE IN ADDITION TO FORM 0068, BOOK AND SUPPLY FORM

ENTER THE FOLLOWING INFORMATION (REQUIRED OR RECOMMENDED) WHERE
INDICATED:

    1.    Five digit Course Reference Number.  If unknown, refer
          to the Schedule of Classes of the appropriate term.

    2.    Four digit Course Number.

    3.    Title of the Course.

    4.    Central Printing Use Only:  Date request was submitted
          to Central Printing by the instructor.

    5.    Date material must be delivered to the University Book
          Center/Health Book Center for sale to students.

    6.    Quantity need for student use. (Health Professions:
          Contact the Health Book Center
          All others: Contact the University Book Center)

    7.    Quantity needed for instructor's use. (Desk copies).

    8.    The instructor's name. (Not the person submitting the
          request)

    9.    Campus Address of the instructor. (Room Number and
          Building)

   10.    Campus Telephone Number of the instructor.  (If rarely
          available, include campus telephone number of
          departmental secretary.)

   11.    Copying Instructions.  Check one to indicate the
          following:

          Simplex - Single-sided copy.
          Duplex - Double-sided copy.
          Other - both single and double-sided copy for one job.

   12.    Binding Instructions.  Check one to indicate the
          following:

          Staple - One staple, upper left.
          Spiral - (GBC) plastic spiral bind.
          Other - Two staples, left, top, etc.

   13.    Copyright.  Check one to indicate the following:

          Original Work - Text was originated by the instructor.
          Permission Required - Copyrighted material is included
          in the text, permission to reproduce required.
          (Instructor must identify copyright owner.  Central
          Printing will obtain permission.)
          Permission Granted - Copyrighted material is included
          in the text, permission to reproduce previously
          granted.  (Copy of written permission must be
          attached.)

   14.    Check Yes/No to indicate whether materials were used
          previously.  If Yes, indicate the term used.

   15.    Signature of Instructor and Date.


For Central Printing/University Book Center/Health Book Center
Use Only:

   16.    Job Number.

   17.    Purchase Order Number.

   18.    Total number of copies, including student copies,
          instructor copies, and Book Center Copy.

   19.    Number of original pages.

   20.    Cost per book.