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Course Information
*Course Name:		*Course Number:
*Term/Semester:		*Year:
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Permission is requested for the following material:
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Chapters:
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Material will be distributed in the following format(s): Check all that apply.*		Print Classroom Management System (TWEN, Bb) Video/Audio Broadcast Other:
Who will access the information?: Check all that apply.*		Only students in the course Other:
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What is the source of the original materials you will use to make the reproductions?: Check all that apply.*		Text Scanned Images Electronic Files Other:
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