Please use a separate form for each item.
All Requests for Supplementary Textbook/Student Purchase Item 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 supplemental textbooks or student purchase items that may be required for a section, or
sections, of a course. Textbook Rental Service does not purchase textbooks for workshops, special courses, independent
study, internship, research, or thesis courses. Also, included in this category, are: additional reading materials, not
considered to be basic textbooks, workbooks, study guides, periodicals, dictionaries, reference books, handbooks, manuals,
laboratory manuals, and any type of consumable materials. These types of textbooks and/or supplies are not issued or sold
by Textbook Rental Service. These items can be purchased through the Union Bookstore.
Supplementary textbooks and student purchase items may be approved for student purchase if the instructor
considers it desirable and the Department Chairperson approves the request(s).
The item cannot exceed one-half the current year’s approved Textbook Rental Service course maximum.
If software is included, the item cannot exceed one-half the current year’s approved Textbook Rental
Service course maximum plus $25.00. If more than one request is being submitted for a class, the total
cost of the requests cannot exceed the above limits.
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(s) is to be available for purchase during a semester/term.
All Information Below Must Be Completed to Avoid Denial Of The Request
Description of item (i.e. workbook, manual, etc.)
List Price Per Copy
Date of Publication
Course/Course #
Estimated Enrollment
Instructor’s Contact Information
Name of Instructor (Please Print)
Signature of Instructor
Department Chairperson’s Contact Information
Name of Department Chairperson
(Please Print)
Signature of Department Chairperson
Date of Request
Approval by Textbook Rental Service
If digital access is needed, a separate form, Request for Supplementary Student Purchase for Digital Access, is to be used.
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