Distance Education Library Instruction Form

Distance Education Library Instruction Request

Please fill out this form to request library instruction online, at an EKU regional campus, or via Internet Television (ITV).

Note: Please be sure you receive a confirmation message after you click "Submit".

Instructor Information

Instructor First Name: *	A value is required.
Instructor Last Name: *	A value is required.
Email Address: *	A value is required.Invalid format.
Daytime Phone Number:
Evening Phone Number:

Course Information

Course Name: *

A value is required.

Date Instruction Needed: *

A value is required.Invalid format: enter date as mm/dd/yy

Course Time: *

A value is required.Invalid format: enter time as hh:mm

Class Location: *

Please select an item.

Class Format: *

Please select an item.

Are you using Blackboard in this course?

Yes

Are there students with disabilities in the class?

Yes

Class Assignment: *

A value is required.

Topic(s):