Media Request Form


Materials are available on a FIRST COME, FIRST SERVED basis.

Loan Period

DVDs and videocassettes may be checked out by faculty for seventy-two hours. Materials borrowed for student use are the sole responsibility of the faculty member authorizing this form.


Materials may be delivered to departmental offices.

Personal Information: (** indicates a required field)
Instructor's Name: **
OneCard Barcode or
TU ID Number:
Department: **
Phone Number: **
Email Address: **

Video Information: (** indicates a required field)

Title: **
Catalog Number: **
Show Date: **
Alternate Show Date: **


Would you like to pick up the media item or have it delivered?
  Pick up at Circulation Desk
Delivery -- If so, enter location and date:
Date Required:

Other Requests and Comments

We will contact you regarding availability of these other items.

Media Request Form / Albert S. Cook Library
Last revised: May 12, 2014

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