<h2 class="bodytitle">Reserve DVD/VHS Request</h2>
<ul>
<li>This service is <strong>restricted to SIUE faculty</strong>.</li>
<li>This form is for <strong>DVD/VHS Media</strong> <strong>only</strong>. Other forms are available to <a href="/id0904f67a801f8f56">request journal articles</a>, <a href="/id0904f67a801f8f4b">books</a> and <a href="/id0904f67a801f8f52">book chapters</a>.</li>
<li>Items in <span style="color:#ff0000;">red</span> are required.</li>
<li>Up to five books may be requested per form. Please use as many forms as necessary.</li>
<li>After you send your Request, an acknowledgment will appear in your Web browser.</li>
</ul>
<form action="http://www.library.siue.edu/lib/forms/media_reserve.php3" method="post">
<h3 class="bodytitle">Instructor</h3>
<table border="0">
<tbody>
<tr>
<th class="bigbodytitle" align="right"><span style="color:#ff0000;">Faculty Name</span>:</th>
<td class="bodytext"><input name="Name" size="30" /></td>
</tr>
<tr>
<th class="bigbodytitle" align="right"><span style="color:#ff0000;">Office Telephone</span>:</th>
<td class="bodytext"><input name="Sphone" maxlength="7" size="7" /></td>
</tr>
<tr>
<th class="bigbodytitle" align="right"><span style="color:#ff0000;">E-Mail Address</span>:</th>
<td class="bodytext"><input name="Email" /></td>
</tr>
</tbody>
</table>
<h3 class="bodytitle">Course</h3>
<table border="0">
<tbody>
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<th class="bigbodytitle" align="right"><span style="color:#ff0000;">Course Prefix</span>:</th>
<td class="bodytext"><select name="CoursePref" size="1"><option selected="selected">ACCT </option> <option> AD </option> <option> ADED </option> <option> ANTH </option> <option> ART </option> <option> AS </option> <option> BIOL </option> <option> BSED </option> <option> CE </option> <option> CHEM </option> <option> CHIN </option> <option> CI </option> <option> CIS </option> <option> CIV </option> <option> CJ </option> <option> CMIS </option> <option> CNST </option> <option> CS </option> <option> DANC </option> <option> DS </option> <option> ECE </option> <option> ECON </option> <option> EDAD </option> <option> EDFD </option> <option> EDUC </option> <option> EE </option> <option> ENG </option> <option> ENSC </option> <option> ENVS </option> <option> EPFR </option> <option> ESCI </option> <option> FAC </option> <option> FIN </option> <option> FL </option> <option> FR </option> <option> GBA </option> <option> GEOG </option> <option> GER </option> <option> GRK </option> <option> GRN </option> <option> HE </option> <option> HED </option> <option> HIST </option> <option> HS </option> <option> HUM </option> <option> IE </option> <option> IME </option> <option> IS </option> <option> IT </option> <option> ITAL </option> <option> KIN </option> <option> LAT </option> <option> LIBS </option> <option> MATH </option> <option> MBA </option> <option> MC </option> <option> ME </option> <option> MGMT </option> <option> MKTG </option> <option> MS </option> <option> MSC </option> <option> MUS </option> <option> NURS </option> <option> OR </option> <option> PAPA </option> <option> PE </option> <option> PHAS </option> <option> PHEP </option> <option> PHIL </option> <option> PHPR </option> <option> PHPS </option> <option> PHYS </option> <option> POLS </option> <option> PROD </option> <option> PSYC </option> <option> RUSS </option> <option> SAB </option> <option> SCI </option> <option> SOC </option> <option> SOCW </option> <option> SPAN </option> <option> SPC </option> <option> SPE </option> <option> SPPA </option> <option> STAT </option> <option> THEA </option> <option> UNIV </option> <option> WMST </option> </select></td>
</tr>
<tr>
<th class="bigbodytitle" align="right"><span style="color:#ff0000;">Course Number</span>:</th>
<td class="bodytext"><input name="CourseNo" maxlength="4" size="4" /></td>
</tr>
<tr>
<th class="bigbodytitle" align="right"><span style="color:#ff0000;">Section Number</span>:</th>
<td class="bodytext"><input name="SectionNo" maxlength="6" size="6" /></td>
</tr>
<tr>
<th class="bigbodytitle" align="right"><span style="color:#ff0000;">Academic Term</span>:</th>
<td class="bodytext"><select name="Term"><option>Summer 2012 </option> <option> Fall 2012 </option> <option> Spring 2013 </option> </select></td>
</tr>
<tr>
<td><br /></td>
</tr>
</tbody>
</table>
<h3 class="bodytitle">Current Reserve Materials</h3>
<table border="0">
<tbody>
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<th class="bigbodytitle" align="right">Action to be Taken:</th>
<td class="bodytext"><input name="Special" type="radio" checked="checked" value="New" />New<br /><input name="Special" type="radio" value="Renew" />Renew<br /> <input name="Special" type="radio" value="Remove" />Remove<br /></td>
</tr>
</tbody>
</table>
<h3 class="bodytitle">DVD/VHS 1</h3>
<table border="0">
<tbody>
<tr>
<th class="bigbodytitle" align="right"><span style="color:#ff0000;">Material Format</span>:</th>
<td class="bodytext"><input name="Format1" type="radio" checked="checked" value="DVD" />DVD<br /> <input name="Format1" type="radio" value="VHS" />VHS</td>
</tr>
<tr valign="top">
<th class="bigbodytitle" align="right"><span style="color:#ff0000;">Title</span>:</th>
<td class="bodytext"><input name="Title1" size="30" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Publisher:</th>
<td class="bodytext"><input name="Publisher1" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Year:</th>
<td class="bodytext"><input name="PubYear1" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Copy:</th>
<td class="bodytext"><input name="Volume1" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Call number:</th>
<td class="bodytext"><input name="CallNum1" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right"></th>
<td class="bodytext"></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Loan period:</th>
<td class="bodytext"><input name="Loan1" type="radio" checked="checked" value="2 hour" />2 hour <em>(item must be used on floor 1, 2, or 3 of the Library)</em><br /> <input name="Loan1" type="radio" value="3 hour" />3 hour <em>(item must be used on floor 1, 2, or 3 of the Library)</em><br /> <input name="Loan1" type="radio" value="1 day" /> 1 day<br /> <input name="Loan1" type="radio" value="3 day" /> 3 day<br /> <input name="Loan1" type="radio" value="7 day" /> 7 day<br /> <input name="Loan1" type="radio" value="14 day" /> 14 day</td>
</tr>
</tbody>
</table>
<h3 class="bodytitle">DVD/VHS 2</h3>
<table border="0">
<tbody>
<tr>
<th class="bigbodytitle" align="right"><span style="color:#ff0000;">Material Format</span>:</th>
<td class="bodytext"><input name="Format2" type="radio" checked="checked" value="DVD" />DVD<br /> <input name="Format2" type="radio" value="VHS" />VHS</td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Title:</th>
<td class="bodytext"><input name="Title2" size="30" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Publisher:</th>
<td class="bodytext"><input name="Publisher2" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Year:</th>
<td class="bodytext"><input name="PubYear2" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Copy:</th>
<td class="bodytext"><input name="Volume2" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Call number:</th>
<td class="bodytext"><input name="CallNum2" /></td>
</tr>
<tr valign="top">
<th align="right"><br /></th>
<td><br /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Loan period:</th>
<td class="bodytext"><input name="Loan2" type="radio" checked="checked" value="2 hour" />2 hour <em>(item must be used on floor 1, 2, or 3 of the Library)</em><br /><input name="Loan2" type="radio" value="3 hour" />3 hour <em>(item must be used on floor 1, 2, or 3 of the Library)</em><br /><input name="Loan2" type="radio" value="1 day" /> 1 day<br /> <input name="Loan2" type="radio" value="3 day" /> 3 day<br /><input name="Loan2" type="radio" value="7 day" /> 7 day<br /><input name="Loan2" type="radio" value="14 day" /> 14 day</td>
</tr>
</tbody>
</table>
<h3 class="bodytitle">DVD/VHS 3</h3>
<table border="0">
<tbody>
<tr>
<th class="bigbodytitle" align="right"><span style="color:#ff0000;">Material Format</span>:</th>
<td class="bodytext"><input name="Format3" type="radio" checked="checked" value="DVD" />DVD<br /> <input name="Format3" type="radio" value="VHS" />VHS</td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Title:</th>
<td class="bodytext"><input name="Title3" size="30" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Publisher:</th>
<td class="bodytext"><input name="Publisher3" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Year:</th>
<td class="bodytext"><input name="PubYear3" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Copy:</th>
<td class="bodytext"><input name="Volume3" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Call number:</th>
<td class="bodytext"><input name="CallNum3" /></td>
</tr>
<tr valign="top">
<th align="right"><br /></th>
<td><br /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Loan period:</th>
<td class="bodytext"><input name="Loan3" type="radio" checked="checked" value="2 hour" />2 hour <em>(item must be used on floor 1, 2, or 3 of the Library)</em><br /><input name="Loan3" type="radio" value="3 hour" />3 hour <em>(item must be used on floor 1, 2, or 3 of the Library)</em><br /><input name="Loan3" type="radio" value="1 day" /> 1 day<br /><input name="Loan3" type="radio" value="3 day" /> 3 day<br /><input name="Loan3" type="radio" value="7 day" /> 7 day<br /><input name="Loan3" type="radio" value="14 day" /> 14 day</td>
</tr>
</tbody>
</table>
<h3 class="bodytitle">DVD/VHS 4</h3>
<table border="0">
<tbody>
<tr>
<th class="bigbodytitle" align="right"><span style="color:#ff0000;">Material Format</span>:</th>
<td class="bodytext"><input name="Format4" type="radio" checked="checked" value="DVD" />DVD<br /> <input name="Format4" type="radio" value="VHS" />VHS</td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Title:</th>
<td class="bodytext"><input name="Title4" size="30" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Publisher:</th>
<td class="bodytext"><input name="Publisher4" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Year:</th>
<td class="bodytext"><input name="PubYear4" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Copy:</th>
<td class="bodytext"><input name="Volume4" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Call number:</th>
<td class="bodytext"><input name="CallNum4" /></td>
</tr>
<tr valign="top">
<th align="right"><br /></th>
<td><br /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Loan period:</th>
<td class="bodytext"><input name="Loan4" type="radio" checked="checked" value="2 hour" />2 hour <em>(item must be used on floor 1, 2, or 3 of the Library)</em><br /><input name="Loan4" type="radio" value="3 hour" />3 hour <em>(item must be used on floor 1, 2, or 3 of the Library)</em><br /> <input name="Loan4" type="radio" value="1 day" /> 1 day<br /><input name="Loan4" type="radio" value="3 day" /> 3 day<br /><input name="Loan4" type="radio" value="7 day" /> 7 day<br /><input name="Loan4" type="radio" value="14 day" /> 14 day</td>
</tr>
</tbody>
</table>
<h3 class="bodytitle">DVD/VHS 5</h3>
<table border="0">
<tbody>
<tr>
<th class="bigbodytitle" align="right"><span style="color:#ff0000;">Material Format</span>:</th>
<td class="bodytext"><input name="Format5" type="radio" checked="checked" value="DVD" />DVD<br /> <input name="Format5" type="radio" value="VHS" />VHS</td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Title:</th>
<td class="bodytext"><input name="Title5" size="30" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Publisher:</th>
<td class="bodytext"><input name="Publisher5" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Year:</th>
<td class="bodytext"><input name="PubYear5" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Copy:</th>
<td class="bodytext"><input name="Volume5" /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Call number:</th>
<td class="bodytext"><input name="CallNum5" /></td>
</tr>
<tr valign="top">
<th align="right"><br /></th>
<td><br /></td>
</tr>
<tr valign="top">
<th class="bodytitle" align="right">Loan period:</th>
<td class="bodytext"><input name="Loan5" type="radio" checked="checked" value="2 hour" />2 hour <em>(item must be used on floor 1, 2, or 3 of the Library)</em><br /><input name="Loan5" type="radio" value="3 hour" />3 hour <em>(item must be used on floor 1, 2, or 3 of the Library)</em><br /><input name="Loan5" type="radio" value="1 day" /> 1 day<br /><input name="Loan5" type="radio" value="3 day" /> 3 day<br /><input name="Loan5" type="radio" value="7 day" /> 7 day<br /> <input name="Loan5" type="radio" value="14 day" /> 14 day</td>
</tr>
</tbody>
</table>
<input type="submit" value="Send Reserve Request" /><input type="reset" value="Clear This Form and Start Over" /></form>