Course Prefix and Number

Instructor Name

Office Phone

Other Phone

Office Hours

Email

Number of Students

Academic Level of Students


Please list at least two possible dates and times for your session

Option #1: Date

Option #1: Time
: 24-hour format


Option #2: Date

Option #2: Time
: 24-hour format


Option #3: Date

Option #3: Time
: 24-hour format



Requested Instruction


Class assignments related to library instruction (Optional)


Questions or Comments (Optional)




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