Media Course Reserves Request Form

Requested By:

*Instructor:

*Department:

*Phone:

*Email:

Course Information

*Name:

*Number:

*# of Students:

*Semester:

*Removal Date:

Materials

Please be advised that for cataloging purposes, tattle tape, barcodes, call numbers, and reserve tape will be affixed to all personal copies!

Item #1

*Title:

Distributor:

*Date:

*Choose One:

 Library Material   Personal Material 

Item #2

Title:

Distributor:

Date:

Choose One:

 Library Material   Personal Material 

Item #3

Title:

Distributor:

Date:

Choose One:

 Library Material   Personal Material 

Please let us know if you have any questions, concerns, or comments regarding your request!

*Validation Sound: