Library Instruction Request Form

Instuctor Information

First Name:

Last Name:

Email:

Telephone:

Class Information

Department:

Course Name and Number:

Classroom Location(Building and Room #):

Number of Students:

Preferred Date:

Alternate Date:

Start Time Of Class:

End Time Of Class:

Location:

Classroom

Library Instruction Lab

Online

Type of Instruction:

Single Instruction Session

Embedded Librarian

Additional Information

Please provide a description of the assignment or type of instruction needed including requirements for types of sources.