Book Chapter Reserve Request Form

Today's Date     
Faculty Id#:
E-Mail Address:
Campus Phone Number:
Campus Location/Bldg
Course Name:
Course Number(s):
Date Item Should be Removed from Reserve     
Are there any other instructors using this item: Yes    No
If so, please note the name of the other instructor(s):


Click here if not applicable  

Is this a personal copy or the library's copy?: Personal Copy     Library's Copy

Chapter Author:
Chapter Title:
Page Numbers
Book Title:
Book Author / Editor:
Date of Publication:
Place of Publication:
Additional Instructions or Comments:

The bibliographic citation for the item will be written on the cover page of the copy and a barcode will be added. If this is your personal copy and this is unacceptable please speak to Jacquie Keleher the Circulation Librarian.

All photocopied material must be obtained from an item owned by the library or by the instructor placing the item on Reserve. The responsibility for compliance with the U.S. copyright law regarding photocopied reserve materials rests with the instructor and the user. The Leonard S. Washington Memorial Library is not responsible for securing copyright permission.