Publication Request Form

Contact Information

Name: Office/Program:
Email: Phone:

Publication Information

Name of Publication:
Is this publication tied to a specific event? Yes No
Event Name:
(if applicable)
In-hand Date (Deadline):
Budget Number:
Budget/Grant Balance
Audiences: Prospective Students
Current Students
Parents
Penn State Staff
Penn State Faculty
Penn State Alumni
Penn State Donors
Friends and Neighbors
Other, specify 		Quantity:
Format: Brochure
Poster
Postcard
Flyer
Newsletter
Program
Promotional item/giveaway
Other, specify
I'm Unsure/Open to Suggestions
Purpose/Goal of Publication:
What marketing efforts have you done
or plan to do to achieve this goal?
Does the look of this piece need to fit
with existing materials?		 Yes No
What is the anticipated shelf life of
this publication?
How will this piece be distributed?
Will this piece be sent using bulk mail? Yes No
Details/Specs:
Delivery Destination:
(Room and Building)
Additional Delivery Details:
(if applicable)
Security Code: Please type the following numbers into the box below: 14451