Special Reserve Request Form

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
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