Kirk Library: Item Request form for DL Students

Library Materials Loan Request for Distance Learners

Centralia College students who are not taking classes on the Centralia main campus, but are studying at Centralia College East (CCE), online, or by correspondence may use this form to request that library materials be sent to them by courier (CCE only) or via U.S. mail.

Students may check out:

Books and audio books: 5 items under 1 subject with a total of 25 items [30 days]
Videos and DVDs: 3 items [1 week]
Telecourse videos and DVDs: 3 items [3 days]

Student Information

Student Name: Student ID Number:

Mailing Address:

City: State: Zip Code:

Telephone Number: Email Address:

Information for Item 1

Item type:
Book
Video (VHS)
DVD
Music CD
Magazine/Journal/Newspaper Article
Other:

Call Number (If book, video, CD, or DVD):

Title of book, video, CD, DVD or magazine/journal/newspaper):

Title of Magazine, Journal, or Newspaper Article:

Author:

Publication Date (If magazine, journal or newspaper, provide day/month/year or quarter/year):

Page Numbers (If magazine, journal or newspaper article):

Information for Item 2

Item type:
Book
Video (VHS)
DVD
Music CD
Magazine/Journal/Newspaper Article
Other:

Call Number (If book, video, CD, or DVD):

Title of book, video, CD, DVD or magazine/journal/newspaper):

Title of Magazine, Journal, or Newspaper Article:

Author:

Publication Date (If magazine, journal or newspaper, provide day/month/year or quarter/year):

Page Numbers (If magazine, journal or newspaper article):

Information for Item 3

Item type:
Book
Video (VHS)
DVD
Music CD
Magazine/Journal/Newspaper Article
Other:

Call Number (If book, video, CD, or DVD):

Title of book, video, CD, DVD or magazine/journal/newspaper):

Title of Magazine, Journal, or Newspaper Article:

Author:

Publication Date (If magazine, journal or newspaper, provide day/month/year or quarter/year):

Page Numbers (If magazine, journal or newspaper article):