Request for Off Campus Services
Please fill in all bolded fields
Date Librarian’s Initials _____
Student Information:
Name:
Address:
Phone: Daytime Evening
Email:
Course:
Instructor:
Type of Request:
A. Informational or Reference:
Question:
Answer: _____________________________________________________________________________________________
Source: _____________________________________________________________________________________________
B. Literature Search: (Please attach permission for this service from instructor)
Topic as stated by student:
Keywords:
Date parameters (e.g. last 5 years):
Type restrictions (e.g. research articles):
C. Book Loan:
Author:
Title:
Call #
D. Periodical Photocopy Request:
Periodical title:
Year Month: Pages:
Author of Article:
Title of Article:
I cannot use information after:
Order the information by Interlibrary loan until (date):
Send material as it: comes in
grouped by number (list number)
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