Please printout, complete and forward a copy of this form to
Edgar C. Bailey, Jr. who will coordinate the processing of your request.
You may also phone your request to him at Ext. 2580.

Name ___________________________________

Phone ________________________

Email _________________________

Course Name ____________________________

Course Number __________________

No. of Students __________________

Preferred time and date(s) __________________

Describe Library Assignment:

Librarian will complete this section:

Date Request Received: ______________________________

Date and Time of Instruction: __________________________

Presenter: ___________________Recorded on Calendar: ___