Today's Date:____________________

Division:_________________________

Division Chair's Initials:__________

Title:_________________________________________________

Author:_______________________________________________

Publisher:_____________________________________________

Year:__________  ISBN:__________________  Price:________

Requestor's Name:______________________________________

Please indicate priority:

[ ] Essential

[ ] Important

[ ] Useful

[ ] Would like to have if funds permit

To submit this form, print it out and return it to Margo Borbotsina, Public Services Librarian.  If you have any questions, please call x6541.