Material Request Form

 

Requested by: ___________________________________________________________

 

Date Requested: __________________          Date Ordered: _______________________

 

Circle Appropriate Item(s)

 

Books            DVDs             Videos             Audios             Other

 

 

Titles: ______Include price per item and code________ List in order of priority.

 

1.

 

 

2.

 

 

3.

 

 

4.

 

 

5.

 

 

Total Cost of Items: _____________

 

Information attached:                Y         N

 

Does this material fulfill a curricular need that is not served through resources available in the Learning Resource Center?            _____ YES                  ____NO

 

If purchased, would use of this material by your students be

_____ Required

_____ Optional

_____ Integrated into class lecture

 

Additional notes: