48 Hrs. Lead Time Required for All Requests

BHS Reproduction Request Slip

(48 hrs. lead time required for all requests)

__________

Request by (print) RM. # Date

Department Code:______

___ Number Xerox Copies

___ Front Only

___ Front and Back

___ Collate ___Staple Color______

Please indicate your department:

___ Academic Decath. ___ ELL Office ___ Yearbook

___ Accreditation/WASC ___ Fiscal Office ___ SLC

___ APO ___ Health Office ___Math

___ Attendance Office ___ VPA ___ English

___ AWEC ___ Intersession ___ Social Science

___ Journalism ___ Special Ed. ___ Science

___Cafeteria ___ Leadership ___ Wld Language

___ SRC ___ Library ___ Physical Education

___College Center ___ Main Office ___ Decathlon

___ Couns. Office ___ Student Body

___ Dean & Police ___ Testing

*Please note: department chair is required to approve all request.

Department Chair Approval:______

****

I have read the article, “Notice Warning Concerning Copyright

Restrictions,” by Section 201.14 or Part 201 or 37 CFR Chapter II

of the copyright law.

Teacher Signature: ______

Project completed by: (print) ______