Library Instruction Request Form
Instructor Name
*
Email
*
Phone
*
How many students?
*
Course Number
*
e.g. GEP 100
Preferred Date
Preferred Date
*
/
MM
/
DD
YYYY
Start Time
Start Time
*
:
HH
MM
AM
PM
AM/PM
End Time
End Time
*
:
HH
MM
AM
PM
AM/PM
Additional Possible Dates/Times
e.g. 9/15 @ 10am
Please provide details on your assignment or the work in which your students are engaged:
*
Type the letters you see in the image below.
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