Audio Visual Material Purchase Request

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Requesting Individual/Department:	Date:

Material(s) being requested: (Check one)

DVD	CD	Title Requested:

ISBN #:	UPC Code:

Vendor:	Cost:	each	set

Please answer the following questions to support the requested selection.

1.	What course(s) does this request support?

2.	If two or more DVDs are requested at the same time for the same course, why are multiple visuals needed?

(Support with course content / objectives / competencies)?

3.	What other films are already available in the Library in support of this course?

4.	Can this DVD be used in any other course? List course(s) it applies to.

5.	Does the instructor(s) for the other course support the purchase of this video and plan to use it? (check one)

Yes	No	Instructor(s):

6.	Has this DVD been previewed?	YES	NO	Rating (1 = excellent/10 = poor):

7.	How many films are typically shown in this course each semester?

Electronic Signatures

Date:

Date:

Date: