Reserve Request

Date: *

Semester: *

Instructor Information

Name: *

Department: *

UH Mail Code: *

Phone Number: *

E-Mail: *

Have you completed and submitted an Instructor Reserves Agreement?: *

Yes

Requests will not be processed without a completed Instructor Reserves Agreement on file with the University of Houston Libraries Reserves Department.

Course Information

Course Number:

Course Name:

Number of Students Enrolled in the Course:

Item to be Placed on Reserve:

Have you requested that this item be placed on reserve for previous semesters: *

Yes

Reserve Type

Title:

Author(s):

ISSN/ISBN: International Standard Serial Number

Inclusive Pages:

Volume:

Issue: only required for article requests

Publication Date: Year + season, month, day, if given

Loan Period:

Additional Requests

Optional:

Please attach an MS Word Document or PDF here to be sent along with this form.