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FOR OFF= ICE USE ONLY

OLD COPYRIGHT RC’D

 =

NEW COPYRIGHT RC’D

 =

COMPLETED

 =

SUBSTITUTION REQUEST FORM<= /p>

 

Instructions for submitting a substitution:=

= 1.&n= bsp;    Fill out th= is form and send it with the materials you are requesting a substitution for i= n the same box at the same time to Vali Kremer, using the following guidelines:

·        If using the Post Office, mail to:

Alan Griffin

Uta= h State Office of Education

250 East 500 South

PO Box= 144200

Salt Lak= e City, Utah 84114-4200

·        If using a shipping service, such as FedEx or UP= S, etc., mail to:

Alan Griffin

Utah State Office of Education

     250 East 500 Sou= th 

Salt Lake City, Utah 84111

= 2.&n= bsp;    Substitutio= ns will be completed ideally within two weeks of the date we receive this form= and the materials together. However, there may be times when a high work load requires more time for completion.

= 3.&n= bsp;    If you are requesting a substitution for a whole series, you must submit all grade lev= els.

= 4.&n= bsp;    Please comp= lete a copy of this form for each grade level.

 

Publisher Name:

SERIES NAME:

 

STUDENT EDITION TIT= LE:

 

GRADE LEVEL:

 

Old ISBN=

Old Copyright<= /o:p>

New ISBN=

New Copyright<= /o:p>

Type (Student Editi= on, Teacher Edition, Ancillary)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I, __________________________, understand that if the = above substitution is approved, the old contract will be

        =        Official Signature

void and removed from the Recommended Instructional Materials Searchable Database.

 

 

___________= ________________________________________________

Printed Nam= e of Signee and position of authority.

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