LLC Resource Request Form

Please fill out the form below. Fields with an asterick* are required. Select the submit button when you are done.

Request Date:

*Instructor First Name:

*Instructor Last Name:

*Title/Name of Resource:

Producer/Director:

*Media: Choose One... DVD VHS Game Audiobook Periodical Newspaper Other

*Language:

Suggested Source (i.e. Amazon.com):

Source URL:

Estimated Cost:

Resource to be used in (if applicable):
*Course Number:          *Course Name:

*Department:     Dual Department:

Additional Comments:

Requester E-mail Address: