EDUCATIONAL USE REQUEST FORM

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Please supply the following information about your organisation

Date

Day Month Year

Full name

First name Last name

Company/institution/organisation

Address

Street address

Street address line 2

City County / State

Postal / Zip code Country

Email *

Confirmation Email myname@school.com

Your reference number

Educational entity name

Educational entity address

Street address

Street address line 2

City County / State

Postal / Zip code Country

Details of the Pearson content that you wish to use

Publication title and edition

Author(s)/Editor(s)

ISBN

Copyright year

Chapter number and page ranges in our text

Figure/illustration/photo/table numbers in our text

Page on which content appears

How do you wish to use our content?

Method of distribution (please specify - e.g. print copies, online use)

Course name/number

Date of use

Day Month Year

Professor name

Number of students/users

Course website address

Is online access secure and password protected?

Is our text adopted for this course?

Please add any further information that may help with processing your request

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