Library Instruction Form

Instructor Must Be Present

Required fields are bolded:

First name:   

Last name:   

Department: 

Phone           

This is my

Cell

Home

Work

E-mail

Course Number

Course Name

Number of Students

Room

Preferred Instruction Date -- Please Allow One Week's Notice

Time:

Date:

Alternate Instruction Date:

Time:

Date:

Location

For which type of assignment will your students use library resources?

Paper

Essay

Speech

Project

Other

If other, please describe  

Please tell us specifically what subjects or topics you would like our librarian to cover, demonstrate, or review.