Coursepack Request Form

You must fill out the following form completely for your request to be processed. If information is omitted on this form, our permissions editor will have to contact you via phone, fax, or email before your request can be processed, and this may result in delays.


Requestor's Information

Last Name:

First Name:

Address:

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Country: Country Postal Code:

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Email Address:
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Course Information

Professor/Instructor Name:

Institution:

Department:

Course Name and Number:

Semester:

Expected Enrollment:


University of Michigan Press (UMP) Book Information

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Author/Editor of Book:

ISBN:

Year of Publication:

Page Number(s):


Comments/Additional Information

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