IMR Media Reserve Request

Please note:
Submission of form does not guarantee that the reserve is in effect. An IMR staff member will contact you to confirm the reserve request.

* This information is required to complete this form. There is a 2-week limit for reserve items.
Date:
Title:*		Catalog #:

Requested by:*

Department:*

Phone:

E-mail:*

Box #:

Date needed:

Begin:*		End:*
Class Time:*		Course No:*

Instructions:*

(select appropriate item)

Pick up at IMR circulation desk (Person picking up video materials must present requesting faculty member's ID at time of checkout.) See our proxy checkout page for info on how to set up and use this new service.

Students will view in IMR:

Have Students sign roll after viewing program?	Yes	No
Additional Information: dfdfsfsdfsdfsdfsdfsdfsdfss