Faculty Name: ......................................................... Phone: ......................

Dept. and Course #: ...................... Title: ....................................................

Date Rec'd: ...................

List #: ..........................

Proc By: .......................

Please: (1) Submit a separate, typed (or word-processed) list for each course; (2) Provide complete citations for items without call numbers; (3) Double space between items; (4) If your Departmental Library Representative has not signed here, you are responsible for book orders placed at your request: ................................................................

*Please enter the following codes for format: B (book), S (score), R (recording), V (video), L (laserdisc), D (DVD), X (xerox), P (periodical), M (personal copy), or O (other). Please photocopy additional copies of this form as needed.