Personal
Information
|
|
*Name:
|
|
|
*Account / Institution of Employment:
|
|
|
*Department:
|
|
|
*Address:
|
|
|
*City:
|
|
|
*State:
|
|
|
*Zip:
|
|
|
*Office Phone:
|
|
|
Home Phone:
|
|
|
Fax:
|
|
|
Email:
|
|
|
Tenured?:
|
|
Academic Information
|
|
Academic Degree #1:
|
|
|
Degree 1 Recieved From:
|
|
|
|
|
Academic Degree #2:
|
|
|
Degree 2 Recieved From:
|
|
|
|
|
Academic Degree #3:
|
|
|
Degree #3 Recieved From:
|
|
|
|
|
|
Awards Recieved:
|
|
|
Writing Experience
|
|
|
Professional Organization Affiliation(s)
|
|
Topic Information
|
|
*Course I would like to write
for (topic or content area):
|
|
|
I currently teach a course on this topic:
|
|
|
Current Enrollment for this course at my institution is:
|
|
|
Current Book / Product In Use for this course:
(Author/Title/Edition/Publisher):
|
|
Project Details
|
|
*Project Name / Title
|
|
|
Product Type(check all that apply)
|
|
|
Media Format (check all that apply):
|
If Other, please describe:
|
|
*Give a brief description of
the project:
|
|
|
*What is compelling about this
project? That is, what is unique about this idea, and what makes it different
or better than what is already available?
|
|
|
Where do you envision this product being used (check all that apply)? *
|
|
|
Have you contacted another publisher regarding this project?*
|
|
|
*Target Completion Date:
|
|
|
Co-Author?
|
If yes, please enter the following information in the Comments box at the
bottom of this form (Name, School/Company, Address, City, State, Zip, Phone,
Email, Other).
|
|
*What materials are available
now for submission? (i.e. Chapter, outline, prototype, resume, etc.) If nothing
is ready at this time, please type 'None'.
|
|
|
Project Comments: anything would you like to add?
|
|
|
|