UNIVERSITY OF PITTSBURGH FORM INSTRUCTION GUIDE 

FORM NUMBER:      FORM CCC 0002

FORM TITLE:            Coursepack Request Form

PROCEDURE:           05-05-01

EFFECTIVE DATE:    November 9, 1993

PAGE (S):                   1

 

TO BE COMPLETED BY THE REQUESTER

(Use a separate sheet for each course number)

Course Information

1.   Date of the request (MM/DD/YY).

2.   Date when the term begins (MM/DD/YY).

3.   University of Pittsburgh.

4.   Subject abbreviation.

5.   Four-digit course number and five-digit course reference number. If unknown, refer to the

      Schedule of Classes of the appropriate term.

6.   Name of the course instructor.

___________________________________________________________________________

Information About Material to be Reproduced

7.   Out of print title? (Yes or No - Circle the appropriate answer)

8.   Indicate whether additional information is attached to the Coursepack Request Form.

      (Yes or No - Circle the appropriate answer)

9.   ISBN/ISSN - International Standard Book Number/International Standard Serial Number.

10. Author, editor, or translator.  The instructor's name if the text is an original work by the

      instructor, or combined with copyrighted material.  The name of the original author,

      editor, or translator if solely copyrighted material.

11. Name of the publisher or copyright holder.

12. Complete title of the work, the course title if the text is an original work by the instructor,

      or combined with copyrighted material.  The original title, if solely copyrighted material.

      Title of the book or journal.

13. The title of the chapter or article to be reproduced.

14. The author of the chapter or article to be reproduced.

15. Total number of pages to be reproduced.

16. Indicate the page number of the first page to be reproduced.

17. Indicate the page number of the last page to be reproduced.

18. Copyright year (2 digits), e.g. 1993 would be written as '93.

19. Publication year (if different than the copyright year).

20. Volume number.

21. Edition number.

__________________________________________________________________________

TO BE COMPLETED BY THE BOOK CENTER

22. Document reference number assigned by Book Center.

23. Purchase Order number assigned by the Book Center.

24. Line item reference number assigned by the Book Center.

25. Copyright Clearance Center account number.

26. The Book Center, University of Pittsburgh.

27. Name of individual to contact in case of questions.

28. The Book Center address.

29. City, state, and zip code.

30. Telephone number (including area code).

31. Telefax number (including area code).

32. Number of sets requested.  To be determined from previous enrollments in the course.