FCCJ Libraries

Material Request Form

Please use one form per requested item, and fill in as much information as you can. Return to your Campus Library. Call your campus librarians with any questions. Thanks for helping us build our collection!

Your Name:____________________________________

Your Academic Area:_____________________________

Your Phone Number and/or Email Address:_____________________________

If you have any printed information about the resource (ad, review, web site, catalog page, etc.), please attach it to this request form.

Needed by: (Please specify term if needed for course)_____________________

Title of Item:______________________________________________________

Format (Circle one):

Book VHS Tape CDROM DVD Audio CD Audio Cassette Other________

Author:______________________________________

Publisher:____________________________________

Date: __________________

Edition:_________________

ISBN: __________________

Price: __________________

Supplier Information (If this item is from a specialized supplier, such as PBS Video):___________________________________________________________

________________________________________________________________

Is this item to be used for a specific class or assignment? If so, please list the class or briefly describe the assignment: