Reserve Request Form, Western University of Health Sciences

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Reserve Request Form

If any information is missing or if the course instructor did not originate the request, Library Staff will need to contact the department to get the correct information. To avoid delays, please include all the required information.

Instructor: First Name*

Last Name*: ID:

Email*

Phone #*

Course #*

Course Name:

Department*

Item Type*

Video Book Photocopy Other

Viewing instructions for Videos and CD’s

Title of item *

# of copies

Also known as

May be copied*

Yes No

Library use only*

Yes No

Overnight checkout

Yes No

Reserve Beginning Date *

Reserve Ending Date *

Delivery*

	Item is owned by the library.
	Will deliver reserve to the circulation desk. (Must be delivered 24 hours before notification that item is on reserve. CD’s must arrive 48 hours prior.)
	Will deliver reserve via inter-office mail. (Must arrive 24 hours before notification that item is on reserve. CD’s must arrive 48 hours prior.)