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Suggestion Box Form

Survey/Form Review
Library Instruction Request
1. Instructor name:

2. Instructor email

3. Instructor telephone number or extension

4. Course Title & Number

5. Number of students in class:

6. Instruction time of class (start/finish) (Example: MWF 10-10:50; TTH 2-3:15)

7. Desired date of instruction (mm/dd/yy):

8. Second choice of date(s) for instruction (mm/dd/yy):

9. Are your students working on a specific assignment?

10. Which library resources would you like highlighted in the session?

11. Would you like a physical tour of the library for your students?