Name of Faculty/Staff making request:

Course Name:

Date of session being requested:

Time session is to begin: 8 a.m. 1p.m. 6p.m.

Time session is to end: 11 a.m. 4 p.m. 9 p.m.

Number of students to attend:

Please comment on what topics, information or contents that need to be covered in the session.

Adapted from Freed-Hardeman University Library Instruction Request Form. 03/04/04