Appendix C

Below is the ALA version of a blank ILL form. The elements in bold type are elements of description that adhere to national standards. To download a usable version of this form, visit the Website of the References and User Services Association of the American Library Association. The forms can be found at the following URL: http://www.ala.org/rusa/stnd_illformprint.html

Interlibrary Loan Request Form:

Request No.:            Date:                Need before:              Notes:              

Call No.:                          

Patron information:

Book author, OR, Serial title, volume, issue, date, pages; OR Audiovisual title:

Book title, edition, imprint series; OR, Article author, title:       This edition only

Verified in; AND/OR Cited in:

ISBN, ISSN, LCCN, or other bibliographic number:

Request complies with                                        Authorization: ________________

[  ]  108(g) (2) Guidelines (CCG)

[  ]  other provision of copyright law (CCL)                Telephone: ___________________

        TYPE OF REQUEST:

             [   ]             LOAN; WILL PAY FEE _______

             [   ]             PHOTOCOPY; MAX COSTS ___

             [   ] 

        LENDING LIBRARY REPORT: Date

        Date shipped:_____________ via ______

        Insured for   $ _________Charge $ _____

        DUE ______________   [  ] Return insured

        Packing Requirements

        RESTRICTIONS:   [   ] Library use only

        [   ]  Copying not permitted

        [   ]  No renewals   [   ]  _______________

        NOT SENT BECAUSE: 

        [   ]  In use   [   ] Lacking    [   ]  Not owned

        [   ]  At bindery   [   ]  Cost exceeds limit

        [   ]  Non Circulating   [   ]   Lost

        [   ]  Not found as cited   [   ]  On order

        [   ]  Not found on shelf

        [   ]  Lacks copyright compliance

        [   ]  In process  [   ]  Request on _____

        [   ]  Hold placed  [   ]  Poor Condition

        [   ]  Estimate Cost of Loan $ _________

        Photocopy $ ____ Microfilm/fiche $ ____

        [   ]  Prepayment required

        BORROWING LIBRARY REPORT:

        Date received _____   Date returned _____

        Returned via ________  Insured for $ ____

        Payment provided $ __________________

        RENEWALS:

        Date requested ______________________

        New due date _______________________

        Renewal denied _____________________