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Your Name

Your Title



Street address

City, state, and zip code

Your Email

Office phone

Is this decision individual or committee?

 Individual Committee

Other members of this committee who should receive a copy of this book

Title of course

Number of students

Number of sections

Adoption decision date

Likelihood of change

 Excellent Good Fair Not likely

College/university bookstore/textbook buyer’s name

Phone number


Upon receipt of the complimentary copy, I agree to review your book and consider it for adoption. If I adopt the book I will contact my bookstore and request that it order the book in sufficient quantity for my class. If this book is positively reviewed but not adopted, I agree to recommend it to my students for bookstore and/or library purchase.

 yes no

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