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Distance Education Journal Article Request Form


Instructions:

Complete ALL sections of the form or we will not be able to process your request.
Text boxes can be edited if you make a mistake
.
Click on the Clear button to cancel any entered information.
Click on the Submit button after you have completed the form.

 

Verification Information

All fields marked * are required.

*Please select a category:

*Distance/Online Courses:

Contact Information

All fields marked * are required.

*First Name:
Middle Initial:
*Last Name:
*Home/Cell Phone:
*Email Address:
 

(e.g., John@yahoo.com)

*Street Address:
Apartment or Suite:
 

(e.g., #H-102)

*City:
*Zip Code:
*State:

Article Information

All fields marked * are required.

*Journal Name:
*Title of Article:
*Author:
*ISSN(if available):
*Volume Number:
*Issue #:
*Date of Issue:
*Page #:
*Where did you find this journal citation:

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