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Special Reserve Request Form
Instructor's Name ________________________________             Copyright Clearance _______
Department___________________Telephone_________________     Password____________
Course Number_______________Course Title___________________________________________
Reserve Dates: From__________ to __________
What should the library do with these materials after the above dates?_________________________________
NB: Item description may include such information as date, number, and course for an exam; call numbers for books; journal titles for articles; or other relevant information.
Pages of item can be the page range of an item or the number of pages or both.
TITLE  ITEM DESCRIPTION    PAGES OF ITEM   # OF COPIES
1.      
2.      
3.      
4.      
5.