With this form, you will also need to submit the following (via e-mail or the post):

-a copy of the title page and verso of the title page (the copyright page)

-back cover copy

-the first chapter of the book 

 

If you are submitting a work of fiction, you will also need to include a one-page synopsis, summarizing the major events and plot points, including setting, main characters and/or their ethnicities (if relevant), and genre information.  This synopsis will be used to provide appropriate subject headings.

If submitting a work for children, include the entire text.  Works for children must also include a synopsis of 25 words or less.  This will be exactly copied into the CIP data block, so edit carefully.

If using e-mail, please submit these as text in the body of the e-mail.

CIP Data Form:

Full name of author(s), illustrator(s), editor(s) and others listed on title page, in this order: last name, first name, middle name, and birth date:

Has author published any other works?  If so, list:

If author has published other works, give a few details about him/her -- geographical location or occupational information -- to differentiate him/her from anyone else currently writing under the same name.

Title, subtitle, author(s), editor(s), illustrator(s) in the exact order they appear on the title page:

Series title (if any):

Number (if any) of this title in series:

ISBN:

LCCN (PCN):

Bibliographical references (this is a list of sources - books, websites, etc. that you used to research your book)?  yes/no

Index?  yes/no

Name of publisher:

Location (city/state) of publisher:

Projected publication date:

Is this a new edition, 1st edition, revised edition, etc. of the book?

If yes, how will it appear on the title page?

Categorize the work:  fiction, poetry, juvenile (meaning a book written specifically for children), (auto)biography, textbook, other

If juvenile, what is the age or grade range?

List subject(s) of book, including specific geographic areas and/or time periods, if relevant.  This will be converted into the appropriate subject headings.  More information is better than less.  This is a very important part of the CIP data block.

For example, in a book called Square Pegs in Round Holes: How Our Schools are Failing Children with Learning Difficulties the subjects the author gives me might be:  learning disabilities, dyslexia, attention deficit disorder (ADD, ADHD)and  hyperactivity in children and their ability to learn, failure of public schools, multiple learning styles, personal stories and anecdotes, etc.

Your Contact Information:

Name:

Address (include city, state, and zip):

Daytime phone #:

Evening phone #:

Fax #:

E-mail:

Fax, e-mail or snail-mail this form, along with a check for $50 (or pay me via paypal), to:

Adrienne Bashista

P.O. Box 427

Pittsboro, NC 27312