Request Form Name*FirstLastEmail*Phone*Are you a UT student, faculty, or staff member*YesNoUT students, faculty, and staff receive 10 free scans per semester from each department (Digital Library Initiatives, Special Collections, and Map Services)Address*Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCountryRequestItems from*Digital Library InitiativesMap ServicesSpecial CollectionsTheses and DissertationsNumber of Items Requested*12345Item RequestedAuthor*Title*Date*Publisher*Publication Date*Call Number*MS/AR/MPA Number or Call Number*Box Number or Page Number (if applicable)Folder Number (if applicable)Address (URL) of Image File Requested*Ex. http://diglib.lib.utk.edu/image1Image or Collection Name*Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Black and White Print (2.5 feet x 2 feet) - $2.50Black and White Print (2.5 feet x 3 feet) - $3.75Black and White Print (2.5 feet x 4 feet) - $5.00Black and White Print (2.5 feet x 5 feet) - $6.25Black and White Print (3 feet x 2 feet) - $3.00Black and White Print (3 feet x 3 feet) - $4.50Black and White Print (3 feet x 4 feet) - $6.00Black and White Print (3 feet x 5 feet) - $7.50B&W Printing - Price: 50 cents sq. ft. Please select the option that best fits your desired size.Hign Resolution ScanPrice: $10.00Format NeededLow Resolution Scan - $3.00 High Resolution Scan (400 dpi minimum) - $10.00Item Requested - 2Author*Title*Date*Publisher*Publication Date*Call Number*MS/AR/MPA Number or Call Number*Box Number or Page Number (if applicable)Folder Number (if applicable)Address (URL) of Image File Requested*Ex. http://diglib.lib.utk.edu/image1Image or Collection Name*Format NeededLow Resolution Scan - $3.00 High Resolution Scan (400 dpi minimum) - $10.00Black and White Print (2.5 feet x 2 feet) - $2.50Black and White Print (2.5 feet x 3 feet) - $3.75Black and White Print (2.5 feet x 4 feet) - $5.00Black and White Print (2.5 feet x 5 feet) - $6.25Black and White Print (3 feet x 2 feet) - $3.00Black and White Print (3 feet x 3 feet) - $4.50Black and White Print (3 feet x 4 feet) - $6.00Black and White Print (3 feet x 5 feet) - $7.50B&W Printing - Price: 50 cents sq. ft. Please select the option that best fits your desired size.Hign Resolution ScanPrice: $10.00Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Item Requested - 3Author*Title*Date*Publisher*Publication Date*Call Number*MS/AR/MPA Number or Call Number*Box Number or Page Number (if applicable)Folder Number (if applicable)Address (URL) of Image File Requested*Ex. http://diglib.lib.utk.edu/image1Image or Collection Name*Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Black and White Print (2.5 feet x 2 feet) - $2.50Black and White Print (2.5 feet x 3 feet) - $3.75Black and White Print (2.5 feet x 4 feet) - $5.00Black and White Print (2.5 feet x 5 feet) - $6.25Black and White Print (3 feet x 2 feet) - $3.00Black and White Print (3 feet x 3 feet) - $4.50Black and White Print (3 feet x 4 feet) - $6.00Black and White Print (3 feet x 5 feet) - $7.50B&W Printing - Price: 50 cents sq. ft. Please select the option that best fits your desired size.Hign Resolution ScanPrice: $10.00Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum)Item Requested - 4Author*Title*Date*Publisher*Publication Date*Call Number*MS/AR/MPA Number or Call Number*Box Number or Page Number (if applicable)Folder Number (if applicable)Address (URL) of Image File Requested*Ex. http://diglib.lib.utk.edu/image1Image or Collection Name*Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Black and White Print (2.5 feet x 2 feet) - $2.50Black and White Print (2.5 feet x 3 feet) - $3.75Black and White Print (2.5 feet x 4 feet) - $5.00Black and White Print (2.5 feet x 5 feet) - $6.25Black and White Print (3 feet x 2 feet) - $3.00Black and White Print (3 feet x 3 feet) - $4.50Black and White Print (3 feet x 4 feet) - $6.00Black and White Print (3 feet x 5 feet) - $7.50B&W Printing - Price: 50 cents sq. ft. Please select the option that best fits your desired size.Hign Resolution ScanPrice: $10.00Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Item Requested - 5Author*Title*Date*Publisher*Publication Date*Call Number*MS/AR/MPA Number or Call Number*Box Number or Page Number (if applicable)Folder Number (if applicable)Address (URL) of Image File Requested*Ex. http://diglib.lib.utk.edu/image1Image or Collection Name*Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Black and White Print (2.5 feet x 2 feet) - $2.50Black and White Print (2.5 feet x 3 feet) - $3.75Black and White Print (2.5 feet x 4 feet) - $5.00Black and White Print (2.5 feet x 5 feet) - $6.25Black and White Print (3 feet x 2 feet) - $3.00Black and White Print (3 feet x 3 feet) - $4.50Black and White Print (3 feet x 4 feet) - $6.00Black and White Print (3 feet x 5 feet) - $7.50B&W Printing - Price: 50 cents sq. ft. Please select the option that best fits your desired size.Hign Resolution ScanPrice: $10.00Format NeededLow Resolution Scan - $3.00High Resolution Scan (400 dpi minimum) - $10.00Additional InformationPlease add any additional information you feel is relevant to completing your requestMaterials will be published in:TitlePublisherPublication DateTerms of UseUsage Agreement*I have read and agree to the materials usage rights statementScanning FeesHandling Fee$10.00Total$0.00UT students, faculty and staff, please disregard the payment total. There is no charge for your scans. Library staff will contact you if you have reached your 10 scan per semester limit.There is no fee to digitize University of Tennessee, Knoxville theses and dissertations. Please allow about one week for order requests to be completed.Send payment to: University of Tennessee Libraries 171 Hodges Library 1015 Volunteer Blvd. Knoxville, TN 37996-1000 Checks or money order only, made to “University of Tennessee”. Please allow about one week for order requests to be completed after payment is received.Check or money order only, made to “University of Tennessee”. Most orders (under 10 items) can be completed the next business day. Please contact the Map & Geospatial Data Librarian, Greg March, gmarch@utk.edu with any questions.Please note that for Special Collections material, fees are per page scan, not collection. Price may change based on final page count. Send payment to: University of Tennessee Libraries 120 Hodges Library 1015 Volunteer Blvd. Knoxville, TN 37996-1000 Checks or money order only, made to “University of Tennessee”. Please allow 3-4 weeks for order requests to be completed after payment is received.