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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