Library Instruction Request Form

Submitting this form does not guarantee your instruction session. You will be contacted by a librarian to confirm the date, time, and location of the instruction session.	Yes
*Name
*Phone Number
*E-mail
*Office Address
*Course name and number
*Days that class meets
*Room class meets in
*Class beginning and ending times
Date and time requested for library instruction session
*1st Choice
*2nd Choice
*3rd Choice
Please list three outcomes you would like this instruction session to work towards
1st Outcome
2nd Outcome
3rd Outcome
Number of students attending the session?
Do you have any students with special needs?	Yes No
If so, how can they be accommodated?
Please submit the assignment your students will be working on via email or through campus mail to Steven Kenneally, Library 135D.
I have sent the assignment	Yes

	* shows the required fields.