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Textbook Adoption Form

1. Course Information (one course per form)

Instructor's Last Name
Instructor's First Name
Department
Complete Course Title
Course Number
(7-10 digits, include hyphens ie.. 15-ENGL-201H )
Section Numbers (3 digits each)  

Campus Where Course Is Being Taught

Clifton/West/Other
Medic/East
OMI/CAS
Clermont
Raymond Walters

2. Academic Period (check only one)

Fall Quarter (Deadline: MAY 15)
Winter Quarter (Deadline: OCT 15)
Spring Quarter (Deadline: JAN 15)
Summer Quarter (Deadline: APRIL 15)

3. Other Information

Submitted By
UC ID # (exclude hyphens)
Date (MM/DD/YY)
E-Mail Address
Mail Location
Campus Phone
Other Phone

4. Book/Supply Information

Quantity Author (last name of first author)
Title or Description
ISBN # (10 digits, exclude hyphens)
Edition/Year Publisher/Other Source

Required Optional

Paper Cloth

Quantity Author (last name of first author)
Title or Description
ISBN # (10 digits, exclude hyphens)
Edition/Year Publisher/Other Source

Required Optional

Paper Cloth

Quantity Author (last name of first author)
Title or Description
ISBN # (10 digits, exclude hyphens)
Edition/Year Publisher/Other Source

Required Optional

Paper Cloth

Quantity Author (last name of first author)
Title or Description
ISBN # (10 digits, exclude hyphens)
Edition/Year Publisher/Other Source

Required Optional

Paper Cloth

Quantity Author (last name of first author)
Title or Description
ISBN # (10 digits, exclude hyphens)
Edition/Year Publisher/Other Source

Required Optional

Paper Cloth

This is a continuing course.

Comments

Please forward copy of adoption to me via campus mail.