UNIVERSITY OF PITTSBURGH \ FORM INSTRUCTION GUIDE



FORM TITLE:              CUSTOM COURSE MATERIAL COPYING REQUEST
NUMBER:                  FORM 0190 PITT 1883
PROCEDURE:               05-05-01


                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 needed.

   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.

Reproduction Specifications

   18.    Copies (Check all that apply).

          -    S/S - Single-Sided
          -    D/S - Double-Sided
          -    3HP - 3-Hole Punch

   19.    Binding (Check one).

          -    Spiral
          -    Staple
          -    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)

   20.    Covers

          -    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:

          -    Enclosed
          -    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