Please provide all information requested to ensure the successful adoption of a new Textbook. Textbook information can be verified by checking the websites of the publishers. Submit as many forms as needed. Please submit one (1) text per form.

Submission Date*

Month Day Year

Requestor Name*

Requestor E-mail*

Course #*

CRN#*

Semester*

Year*

Title:*

Author(s):*

Publisher:*

Edition:*

ISBN:*

Backing:*

P: Paper Backing H: Hardcover Backing S: Software

Textbook Status*

Desk Copy-Do you need one ordered?*

Yes No

Message: