Copyright Request Form
To be used for APS Curriculum Writers
Date of request:
5/20/2013
Course Name:
Course Number:
Course Writer:
Email address:
ISBN/ISSN Number:
Author/Editor/Translator:
Publisher/Rights Holder:
Book/Journal Title:
Chapter/Article Title:
Author of Article:
Total Number of Pages:
From:
To:
Copyright Year:
Publication Year:
(if different)
Volume:
Edition:
Is the requested material more than 25% of the original work?
Yes
No
Is the requested material out of print?
Yes
No
Please provide any additional information you feel will be helpful?
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