Textbook Authorization Form

Authorization to use Textbooks, Notebooks, Manuals, etc. that were written or prepared by a member of the Faculty or Staff at the University of Texas at Austin. Please complete ALL fields.

Requestor Information:

First Name:

Last Name:

Office:

Email:

Phone:

Department:

School:

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Request Information:

Title of Textbook:

Publisher:

UT Author(s) (separate names by commas and include University title):

Non-UT Author(s) (separate names by commas):

Date of Publication:

For the Fiscal Year: (Requests must be submitted each year)

Cost to Student (per unit in USD):

Monetary Return per Volume per Author (in USD):

Course(s) in which it will be Used:

Reasons for Use:

Used previously at University of Texas at Austin?

Yes No

If Yes, for how many years?

Where else has it been used?

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Comments / Special Instructions:

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