copying row from same table and adding value from form.request

I'm working on a way to copy most data columns from another row in the
same table to a new row and insert the courseID value from the form
that executes this action (the copy).  Is it possible to have both
"values" and "select" in the same Insert Into statement?
Here's what I have (below).  The "CopyCourseID" is the id of the
course that is copied to the new row, although the new row will have a
different course ID ("CourseID").
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strCourseID=Request.Form("CourseID")
Insert table_a(CourseID,Name,Address)
Values(strCourseID)
Select Name, Address
From table_a
Where Course ID = Request.Form("CopyCourseID")
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Thanks,
Louis