COLGATE UNIVERSITY | BLACKBOARD | MY COLGATE | COLGATE GMAIL | WEBMAIL

Media Order Request Form [Colgate community only]

Requestor
First Name:
Last Name
E-mail:
Department/
Campus Address:
Phone:
Colgate Status:
Student Faculty Staff

Reason for request : curricular research recreational (select all that apply)
              Comment :

Is this needed for Reserve? reserve
     Date needed and course number (required) :

Is this a rental or a purchase request ?

Title of film :
Director      :
Year Released:
Vendor or distributor
if known:
Price :
Other details:

Preferred format: DVD Video 35mm 16mm Other (specify in comment box)

If not available in your preferred format, would you accept another format? Yes No

List acceptable formats below along with other comments

      Comment:

Are Public Performance rights nededed ? yes no don't know

Do you have a place and time scheduled for screening this film? yes no

Date / Time needed:
         Alternate date if item is not available for your preferred date:

Location:

Assistance needed to show film: yes no
       Comment:

Page Created & Maintained by your name/email | Last Updated: August 28, 2009 | ©2006
Colgate University Libraries | 13 Oak Drive, Hamilton, NY 13346 | 315-228-7300