Reserves Request
Note: Please read "How to place items on reserve" as well as the directions before completing the Reserves Request Form.
Course & Contact Information
Course Abbreviation & No.: *
Semester: *
Number of Students: *
Instructor's First Name: *
Instructor's Last Name: *
Campus Phone: *
Campus Address: *
E-mail Address: *
Reserve Items
Item 1
Call Number:
Author's First Name: *
Author's Last Name: *
Title: *
(NOTE: This should reflect what's on the syllabus.)
Complete Bibliographic Citation
Publisher: *
Place of Publication: *
Publication Date: *
Number of Copies: *
Loan Period: *
Item 2
Call Number:
Author's First Name:
Author's Last Name:
Title:
(NOTE: This should reflect what's on the syllabus.)
Complete Bibliographic Citation
Publisher:
Place of Publication:
Publication Date:
Number of Copies:
Loan Period:
Item 3
Call Number:
Author's First Name:
Author's Last Name:
Title:
(NOTE: This should reflect what's on the syllabus.)
Complete Bibliographic Citation
Publisher:
Place of Publication:
Publication Date:
Number of Copies:
Loan Period:
Item 4
Call Number:
Author's First Name:
Author's Last Name:
Title:
(NOTE: This should reflect what's on the syllabus.)
Complete Bibliographic Citation
Publisher:
Place of Publication:
Publication Date:
Number of Copies:
Loan Period:
Item 5
Call Number:
Author's First Name:
Author's Last Name:
Title:
(NOTE: This should reflect what's on the syllabus.)
Complete Bibliographic Citation
Publisher:
Place of Publication:
Publication Date:
Number of Copies:
Loan Period:
Item 6
Call Number:
Author's First Name:
Author's Last Name:
Title:
(NOTE: This should reflect what's on the syllabus.)
Complete Bibliographic Citation
Publisher:
Place of Publication:
Publication Date:
Number of Copies:
Loan Period:
Please note that all electronic reserves will have a pre-designated password that is required for access. Instructors will be given password information upon receipt of their reserve request form.
Agreement
I would like my materials returned to me after processing for electronic reserves.*
I have placed personal items on reserve at EKU Libraries with the understanding that these items may be accidentally mutilated, damaged, or lost. I hereby release the Library from all responsibility in replacing any personal materials. I also give the Library permission to process my personal materials as needed for reserve use [barcodes, pockets, labels, etc.]. By signing below, I acknowledge that I understand the terms above. I have read the fair-use statement provided in the directions and I attest that the materials that I have submitted for reserve are in compliance with copyright law.

In order to have your reserves activated you must come to the circulation desk and sign your submitted reserves request form. If you have any questions please e-mail judy.warren@eku.edu.
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Date		 ____________________________________
Signature
  


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