Request for Classroom Library Instruction

Please submit this form at least two weeks prior to the desired session date. We will respond to your request within two business days.

Please note: All sessions will be held in the classroom. Students will have an opportunity to schedule separate instructional sessions as needed.

First & Last Name: *

Email: *

Phone: *

Course# and Name: *

Class location: *

Number of students in class: *

Date requested: *

Month

Day

Year

Time requested: *

Hour

Minute

Desired Session: *

Please list assignment: *

Please list database(s): *

Please list specific topic: *

Learning Outcomes *

What do you hope the students will gain from this session?

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Math question * 9 + 10 =

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