Extramural Part-of-Book Request Form
(For Eligible Extramural Students)

Note: The Library must comply with copyright law and so we can photocopy only a reasonable proportion of any work (normally 1 chapter or article, or 10% of one publication)

Please fill in all fields marked with a * before sending this form.
Full Name:*
Student ID:*
Address:*
Email address:*	If your email address is entered correctly, you will receive an email confirming receipt of your request
Course Number:*
Assignment Number:

Title of book:*
Author of book:*
Date / Edition:
Section to be copied:	Contents Pages Specific Chapter
Title of chapter:
Author of chapter:
Pages:

Information not wanted after this date:
Interloan required:	Yes No
(If material is not held by Massey University Library, indicate if you would like it interloaned from another library. NB: Interloans require PREPAYMENT of $5/item)
Submission of this request amounts to a declaration that you: Require the article for research or private study and will not use it for any other purpose, and Have not previously been supplied with a copy of this reference. This form is for the use of eligible extramural students only.