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Request Service

Digital Conversion Request Form

This form serves the following purposes

• Converting materials into DVDs
• Can work with VHS, SVHS, DVD, MiniDV, DVCam, Film, Etc.
• Materials can be made available online (copyright permission must be granted)
• Slide conversion and digitization

Students: Please do not use this form. Instead, request assistance by emailing mediavision@csupomona.edu or by calling 909 979 6324

First Name
Last Name
Faculty/Staff	Faculty    Staff
E-mail
Telephone
Department
Project Title
If this is for a course, please supply the following: Quarter Course (e.g. 33146)
Media Information Media title Author How will the completed media be used? Brief description of content (What will viewers learn?) Would you like your media to be available in streaming video format? Yes    No Will any copies be sold or given away? Yes    No Is the material copyrighted? Yes    No Is this funded by a grant? Yes     No Desired completion date
Comments/ Additional Info Please type in any additional comments and information below

NOTE: You will receive an email within five working days informing you of the status of your request.