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.