Virsa Digitization Request Form

Use this form to submit incidental (all sizes) and collection-level requests for Digitization services.

Once submitted, a help desk incident (RightNow) is automatically created. All further email communications concerning the request will be taken up later.

Departments requesting digitization services will be informed of the actual costs when necessary.

Name of Requestor (or point of contact):
Meets Which Priority Criteria

Source of Request
Expected use of digitized items:
Items to be Digitized
Requested date of completion: (YYYY/MM/DD)
Short verbal description of request:

Estimated number of individual titles/items:
Example: 2 books and 8
Estimated Total number of pages or items to digitize:
   Example: 2 books=300
   pages + 8
Materials Transfer:

It is the responsibility of the individual requesting digitization services to ensure delivery of materials to be digitized to digitization services staff
(If any) Materials Pickup/Delivery and/or handling/storage information:

List general types & condition of materials:

  • Individual 8x10 photographic prints
  • fragile tightly bound book, etc.

Required specifications (optional) [i.e. directions from professional printer,etc.] If not specified regular standards will be used.


  • 300dpi resolution, 24bit color, TIFF, uncompressed

Short verbal description of form of delivery/deliverables:

  • Standard master archival images on CD-ROM or DVD-ROM
  • Standard web derivative images copied to drive:\directory\..

Other notes or instructions: