Revised Feb. 2015
RESERVE MATERIALS REQUEST FORM
***If you are new to the library, please register for your library card. Library staff can’t create a
reserve unless instructors are registered in the library circulation system.***
Date: _____________
Instructor’s name:____________________________________________________
Course name and number: ____________________________________________
Check item type: Book DVD Photocopies CD VHS Other
Title: ______________________________________________________
Author(s): __________________________________________________
Date to remove from reserve: ____________________
All reserves are library-use only unless you specify differently in the notes below.
Please check one:
I want this material returned to me; it’s my personal material.
I want to donate this material to the library.
Material belongs to the library.
Notes:
(Library staff-use only)
Date reserve created:
Item barcode:
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