Emergency Textbook Request * – indicates a required field. Please use your student email address. Name First Last Student Id* Student Email* Address Street Address City State / Province / Region ZIP / Postal Code Financial Aid Yes No Who referred you to this program? Reason for Book loan request: (loss of income, emergency status)Book Titles & Course Numbers (please enter one book & course per Line)*Total Voucher AmountPlease enter a number greater than or equal to 0.Consent* I consent to this agreement.By signing this agreement, you are acknowledging that these books are the property of the CCC Foundation Office/Student Services and must be returned to the Tutoring Center, Taft Hall 107 by the end of the semester. Replacement Fees: Note by signing this agreement you agree to return the books or you will be responsible for the cost, a bill will be submitted to the business office and a Student Affairs hold will be placed on your student account until the bill is paid! Signature*CAPTCHACommentsThis field is for validation purposes and should be left unchanged.