SILC LSS Media Purchase Request

Faculty, including faculty associates, instructors, and lecturers, may use this form to request the purchase of media for instructional purposes by SILC Learning Support Services.

Before requesting that we acquire a particular title, please search the SILC LSS media catalog, located at  Note that you do not need to log in to the system to search the catalog by keyword.  Once you've verified that LSS does not own the title, please fill out the form below.


Requestor's first and last name.
Requestor's ASU e-mail address.
Requestor's office phone number, if available.
Please indicate the course for which this media is being requested (e.g., Romanian 101 - Beginning Romanian).
Please provide the five-digit course ID for this section (e.g., 17546)
Please attach a syllabus or proposal clearly indicating that the requested media is a requirement for the course.
Files must be less than 2 MB.
Allowed file types: gif jpg png txt rtf odf pdf doc docx zip.
Title 1
Title of requested media.
Title's director, if known.
Year of theatrical or video release.
Please indicate specific languages, subtitles, and features desired. Note that some combinations of language, subtitle, and feature may not be available.