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.
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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:
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