Book Request Form

Name of class*

Contact Information

Choose one of the following options:* Faculty Student

Name*

Address

City

State

Zip code

Phone (xxx-xxx-xxxx)*

Fax (xxx-xxx-xxxx)

Email*

Book information

Title of book*

Author*

Please provide the date after which you will no longer need the item.

I will pick up the book at the*

There may be a fee to cover the postage of mailing it to you.

Data Consent* I agree that by submitting this form/application to Southwestern Community College, I give consent to Southwestern to store and use personal and academic-related information for all recruitment and academic records-related activities. I also agree to allow Southwestern to use multiple forms of communication for the purpose of recruitment and academic-related information during my academic career. I understand that if I do not agree to this statement, this form/application cannot be submitted.

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Book Request Form

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