Brown shield Brown shield Brown shield Brown shield TODO: Replace with department name

Courspacket Order Form

Orders are due 8 weeks prior to class start date.

Course Information

Department:
Course Name:
Course Number: Semester: Est. Enrollment:

Instructor Information

Name:
Title:
Campus Address:
Campus Phone: Alt Phone: Fax#
E-mail Address:
Desk Copies Needed: One free desk copy is supplied for every 15 students who enroll in a course. Additional desk copies may be purchased upon request. Desk copies requested after the course packs have been printed will be charged to the department.
Dept. Account Number (if applicable):

alternate contact information

Name:
Phone: E-mail:

packet information

Was the packet used in a previous semester? yes no
If yes, the packet was used in the Semester and contains
Syllabus to be included? yes no.
Format: Binding:
Special Instructions:
List citations of material to be included.