This form provides a means for faculty to approve extended video borrowing privileges to registered library patrons for academic purposes. See our video page for specific information on borrowing privileges. Your Name * Patron's Name * Patron's Affiliation * W&M Student W&M Language House tutor Other (explain below) If you chose Other, please explain. Choose which of the following special privileges the patron should have (check all that apply) * May check out VHS and laserdiscs May check out DVDs for 7 days May check out an unlimited number of videos (DVD, VHS, and laserdisc) May renew videos an unlimited number of times (DVD, VHS, and laserdisc) Special circumstances start * Day12345678910111213141516171819202122232425262728293031 Day MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Year20182019202020212022 Year Special circumstances end * Day12345678910111213141516171819202122232425262728293031 Day MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Year20182019202020212022 Year By signing below, I approve the aforementioned patron to check out videos with the listed special circumstances. Items are not checked out to your account unless you give the patron permission to do so. Swem Library Circulation staff will contact you to confirm that this form was submitted by you within 48 hours. Signature * Your Department * Leave this field blank Submit
