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Library and Information Services
Library and Information Services
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Media Pickup Request Form

  • This service is restricted to SIUE faculty.
  • This form is for DVD/VHS Media only.
  • Items in bold italics are required.
  • Up to five requests may be submitted per form. Please use as many forms as necessary.
  • After you send your request, an acknowledgment will appear on your Web browser screen.

Instructor

Faculty Name:
Office Telephone:
E-Mail Address:

Course

Course Prefix:
Course Number:
Section Number:
Academic Term:

DVD/VHS 1

Material Format: DVD
VHS
Title:
Call Number:
Pickup Date:
Pickup Time:

DVD/VHS 2

Material Format: DVD
VHS
Title:
Call Number:
Pickup Date:
Pickup Time:

DVD/VHS 3

Material Format: DVD
VHS
Title:
Call Number:
Pickup Date:
Pickup Time:

DVD/VHS 4

Material Format: DVD
VHS
Title:
Call Number:
Pickup Date:
Pickup Time:

DVD/VHS 5

Material Format: DVD
VHS
Title:
Call Number:
Pickup Date:
Pickup Time: