UNIVERSITY OF PITTSBURGH FORM INSTRUCTION GUIDE
FORM NUMBER: FORM 0190 PITT 1883
FORM TITLE: Custom Course Material Copying Request
EFFECTIVE DATE: November 9, 1993
PAGE (S): 2
TO BE COMPLETED BY THE REQUESTER
1. Name of the instructor of the course for which material is to be reproduced
2. Name of the person to contact in case of questions (optional)
3. Campus address of the instructor
4. Department of the instructor
5. Campus telephone number of instructor
6. Home telephone number of instructor (optional)
7. Course number
8. Course name
9. Semester of the course for which material is needed
10. Date Needed - Provide bibliography at least six weeks prior to the date the material is
11. Course enrollment
12. Instructor's Copies - Specify the number of copies needed by the course instructor,
including the one provided free of charge by the Copy Cat.
Material to be Reproduced
13. Is your material an original work (i.e., written by the instructor requesting the material)?
14. Is your material in the public domain (i.e., no longer under copyright)?
15. Does your material require copyright permissions?
16. Will you be obtaining your own permissions?
17. Do you want the Copy Cat to obtain permissions for you? If yes, provide a complete
bibliography at least six weeks prior to the date the material is needed.
18. Copies (Check all that apply).
- S/S - Single-Sided
- D/S - Double-Sided
- 3HP - 3-Hole Punch
19. Binding (Check one).
- Tape (booklets thermal-bound with black tape along the left-hand margin)
- Velo (booklets bound by a plastic strip down the front and back of the left-hand
margin and held by pegs)
- Standard - (navy blue cover with a die-cut window)
- Other - (provide a description of the type of cover needed)
21. The original material (i.e., the material to be reproduced) for this course packet is:
- Will be forwarded no later than two week prior to the due date (i.e., the date needed)
22. Signature of requester and date
TO BE COMPLETED BY THE COPY CAT
23. Special instructions