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Coursepack Request


Information About You

Instructor's Name   

Phone   

Fax   

Department Name   

Location   

MSC   

E-mail address   

Date Needed   


Information About The Course

Course Number   

Course Name   

Section Number(s)   

Total # of Students   


How many copies?

# of Desk Copies      (Note: 1 free desk copy per course)

Org # for Additional Desk Copies  

Total Quantity of Packets   


Printing Details

Copy   

Binding   

3-Hole Binder Size   

Proof   

Contains copyrighted material   

NOTE:  If you selected yes, this form must be accompanied by a completed
Copyright Permission Request Form!

Additional Information:

The Madison Print Services Production Manager reserves the right to eliminate or alter any items
not directly related to content that might impede the production of the coursepack.