Request Form: Video Lending Library: Outreach: East Asian Studies Center: Indiana University

Outreach

Video Lending Library

Request Form

Requested Item(s)

* Indicates a required field

* Item code & * title

Item code & title

Mailing Address

* First Name

* Last Name

* Address 1

Address 2

* City

* State

* Zipcode

* Telephone

Fax

* E-mail

I plan to use the requested item(s) for my teaching

School

Subject

Grade Level

I need the item(s) by

*The date must be at least one week from today.

Special Instructions

I understand that the requested item(s) is on loan to me for teaching purposes only and is not to be given to any other person. I agree to return the item(s) to EASC within one week in good working condition. I agree to pay for the return shipping. If the loaned item(s) are damaged, lost, or stolen, I agree to replace them.

Return Address and Contact Information

Attn: Lending Library
Indiana University East Asian Studies Center
Memorial Hall West 207
1021 E. Third Street
Bloomington, IN 47405-7005
(812) 855-3765 or (800) 441-3272
Fax: (812) 855-7762
easc [at] indiana [dot] edu