Material Request Form
Requested materials must be tied to a course or program.
FUNDING DOES NOT PERMIT PURCHASES FOR PERSONAL INTEREST.
All requests require the approval of your Department Chair or Dean.

Please allow 6 to 8 weeks for servicing this request.

Personal Information
Status: *
Name *
Your answer
E-mail *
MUST USE PGCC EMAIL ADDRESS
Your answer
Phone *
(Home / Work / Campus Ext)
Your answer
Department / Club Association *
Your answer
Request Item
Format *
Title *
Your answer
Author / Director *
Your answer
ISBN
Your answer
Publisher *
Your answer
Copyright Date *
Your answer
In what course or program will the item be used? *
Your answer
Do you need this item by a specific date? *
If yes, please enter the date
MM
/
DD
/
YYYY
How did you find this item? Review, article, catalog… Please enter source information below:
Your answer
If you have an URL, please copy and paste it below:
Your answer
Please provide justification for this purchase: *
Your answer
Please select your Dean or Chair for approval purposes: *
Submit
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