Scanning Request Form

Name*required

Email*requiredinvalid email

Telephone*required 11 digits

School/Service*required

Campus*required   Docklands Stratford Duncan House

Room*required

Agresso cost code*requiredeg ABC123
3 letters, 3 digits

Agresso project code *requiredeg A123456
1 letter, 6 digits

Authorisation*required I confirm that I have received budgetary authorisation for this work to proceed

Authorised by*requiredinvalid email
Email of the person who granted the aurhorisation

Course Code for Course of Study*required

Course title*required

Course of study duration (weeks)*requirednumber

Number of registered students on Course of Study*requirednumber

Author of Extract*required

Page Numbers From*requirednumber To*requirednumber

Source*required   From Paper original owned by Institution From Digital original licensed to Institution From copyright fee paid copy From another HEI under Sharing Provision

Name of supplying institution*required

Primary Reason for Scanning *requiredwhere Digital Version is known to exist   Digital version owned by institution but it is in an unsuitable format Institution does not own or subscribe to digital version N/A

Artistic Works*required   Full page artistic work Artistic work with text Artistic work disembedded from page Not applicable

Notes
an optional message or instructions

Antispam*requiredincorrect, try again
please type in the two words displayed below (audio option is also available)

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