Netflix Request Form

FOR FACULTY ONLY. To expand the options for showing films in the classroom the NIC library offers access to it's Netflix account. Fill out the form below to request a title from the Netflix collection. Browse titles at http://www.netflix.com.


Please read our Netflix lending rules before you fill out this form

First Name:       *

Last Name:       *

Department:       *

Home Telephone #:       *

Office Telephone #:       *

Email address:       *

"Needed by" date:       *

Netflix Information

Title:
*

Director or Producer:

Year:

Comments:

* Required information.