Polk Community College Libraries
Development Services 

Polk Community College
999 Ave H NE
Winter Haven, Fl 33881
(863) 297-1040

LIBRARY MATERIALS REQUEST FORM

The item below is being requested because:

___PCC does not own this item.

___This item is recommended for instructional support.

Item Information
Author(s) / Editor(s):
Title (required):
ISBN/ISSN:
Publisher: Year:
Edition: Price:
Series (if applicable):

Patron Information
Name (required):

Status:    Faculty  ___   Staff  ___   Student  ___
E-Mail Address:
Phone number or Extension:
Department or Snail Mail Address:

Where did you find information on this material?

Please give any additional information that you feel will facilitate filling this request

Please print this form and mail to:
Sarah Johnson, Director of Development Services, Information Technology -- Station #12 Interoffice mail, or email as an attachment to sarahjohnson@polk.edu.