PUBLIC NOTICE OF NONDISCRIMINATION: Northland Pioneer College does not discriminate on the basis of race, color, national origin, veteran status, religion, marital status, gender, age or disability in admission or access to, or treatment
or employment in its educational programs or activities. District grievance procedures will be followed for compliance with Title IX and Section 504 requirements. The Afrmative Action Compliance Ofcer is the Director of Human Resources, 2251 E.
Navajo Blvd., Holbrook, Arizona 86025, (800) 266-7845. The Section 504 Compliance Ofcer is the Coordinator of Disability Resources and Access, 1001 W. Deuce of Clubs, Show Low, Arizona 85901, (800) 266-7845. The lack of English language
skills will not be a barrier to admission and participation in vocational education programs. Revised 9-12-14
4800 Purchase Request Form; MPR/Forms/Library, Revised 12/05/17
You can Print and complete the form by hand or complete the interactive form using Adobe
Acrobat Reader. You can then Submit via e-mail or Save As… to your hard drive for later
re-use. You should print a copy for your records and also submit a copy to the Library via
e-mail attachment, scan or in-person.
Title: ______________________________________________________________________________________________________
ISBN: _______________________________ Year: ________________________ Format: _______________________________
Author: _______________________________________________ Publisher: ___________________________________________
Relates to NPC Department Abbreviation & Course #: _______________________ For NPC Library @: _____________________
(Must fit within the Library Collection Development Policy)
Date: _______________________________ Name: ______________________________________________________________
Do you wish to be notified if the item is obtained? Yes No
Phone: _____________________________________ Email: _______________________________________________________
Mailing Address: ___________________________________ City: _______________________ State: ______ ZIP: ____________
Purchase Request Form
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