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Your Name: [required] Course Name/Number : Semester: Duration: Current Semester Only Until Requested; put date in Instruction box. E-mail address: [required] Title of Item: Author: Call Number: Material type: Book Videotape DVD Video CD Magazine Article Material type: Audio Cassette Tape Audio CD Software CD Software DVD Other Ownership:: Personal Copy (brought to Library by Instructor) WC Collection Other Check Out Instructions: Library Use Only Over Night Two Days Three Days Seven Days *Replacement Cost (Personal Copy or Other): Condition of Material: New Good Fair Poor Other/Special Instructions: Software License Information for a computer file, CD, or DVD One Computer Site License Other I give my permission for copies to be made of this material: Yes No **I have read and agree with statement below: Yes No ** I certify that I am aware of the Fair Use provisions of the Copyright Law of 1976 as it relates to the usage of the material listed above and I will be in compliance with this law. By marking the check box above, I accept liability for any copyright infringements which may be incurred by its existence or use. Notice: It takes 3 days to process materials.
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