Course Prefix and Number
Instructor Name
Office Phone
Other Phone (optional)
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  Example: YYYY-MM-DD
Option #1: Time : 24-hour format
Option #2: Date  Example: YYYY-MM-DD
Option #2: Time : 24-hour format
Option #3: Date (Optional)  Example: YYYY-MM-DD
Option #3: Time (Optional) : 24-hour format
Requested Instruction

Class assignments related to library instruction (Optional)

Questions or Comments (Optional)

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