REQUEST FOR SUPPLEMENTARY STUDENT PURCHASE FOR DIGITAL ACCESS
Please use a separate form for each item
All Requests for Supplementary Student Purchase for Digital Access forms, along with all other
textbook information, must be returned to Textbook Rental Service by the designated deadline.
This form is to be used to request student purchase for digital access that may be required for a section, or sections,
of a course. Digital access is considered a consumable material. These types of consumables are not issued or
purchased by Textbook Rental Service. These items can be purchased through the Union Bookstore.
Supplementary digital access student purchase items may be approved for student purchase if the instructor
considers it desirable and the Department Chairperson approves the request.
This request will not be automatically renewed for successive terms in which the course is offered. A new request
must be submitted each time the item is to be available for purchase during a semester/term.
***All Information Must Be Completed to Process This Request***
Please fill in all shaded areas
Digital Access Information
Date
Submitted:
Course
Title:
Course
Prefix
Course
Number
Section(s) please
list all sections using this
material
Semester Needed
Year:
Publisher/Vendor
Description of Digital Access
(I.E. access codes, online tutorials, registration codes, etc.)
Supplemental Materials Author
(if applicable)
Supplemental Materials Title
(if applicable)
Number of Supplemental Materials Needed
x
x-Instructor signature (written signature required)
Date
xx
xx-Department Chairperson signature (written signature required)
Date
***Textbook Information For Associated Supplementary Material***
Textbook Author
Textbook Title
Textbook Course(s)
Textbook Section(s)
Clear Form
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