Authorization for Out-of-Library Use By Students
Instructional Media Collection

Materials housed in the Instructional Media Collection behind the 2nd Floor Periodicals/Media Desk may be taken out of the library for a class presentation with confirmation from your class instructor. Please print this form and have it signed by your instructor before you come into the library to pick up the material.

Date:	__________________________
Title:	__________________________
Call Number:	__________________________
Borrower:	__________________________
Instructor or
Librarian Signature:	__________________________
Department:	__________________________
Phone#:	__________________________
Due Date:	__________________________
circulation desk clerk initials:	_____________