(
*
indicates a required field.)
*
1).
First Name
*
2).
Last Name
*
3).
Address
4). City
5). State
6). ZIP
*
7).
Email Address
*
8).
Phone Number
*
9). Status
Faculty
Staff
Graduate
Undergraduate
*
10). Department
11). Where did you get
this information?
12).
Periodical Title
13). Article Title
14). Volume
15). Issue Number
16). Month
17). Year
18). Pages
19). ISSN
20).
Book Title
21). Author
22). Publisher
23). Year
24). ISBN
*
25). Check Yes to agree
to the Copyright Restrictions
Notice located at top of form
(Acts as your signature):
Yes