Reserve Request Form

Items marked with a "*" are required fields


INSTRUCTOR INFORMATION
* Instructor's Name (Last, First):
Office Location & Mail Stop:
* E-Mail Address:
Phone:
COURSE INFORMATION
* Subject:
* Course Name:
* Semester/Year:
* Course and Section Number:
Number of Students:
Course website address (optional):
Web based course: Yes No
Permission to link to page: Yes No
Password protect personal items: Yes No
Return Materials by Campus Mail: Yes No
ITEM INFORMATION
**YOU MAY SUBMIT A READING LIST WITH COMPLETE CITATIONS IN LIEU OF THE FOLLOWING.
(You will still need to indicate the LENDING INFO (& PAST USE, if copies) for each item. Send reading list via email or deliver to office.**
* Title (as listed on your syllabus):
* Author or Editor:
* Date or Edition:
Full citation (for copies only):
Past Use (for copies only):
LENDING INFORMATION
Format:
Lending Period:
Duration:
Source of Item:


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