Course Reserves Order Form

· Normal reserve loan period is two hours, and items are restricted to in-house use.
· Other arrangements made on request.

Date request submitted / MM / DD YYYY
Name First Last
Phone - (###) - ### ####
Email
Department
Course Number and Title
If you are placing personal copies on reserve, do you give your permission for the Library to
place a security strip on them? Yes No
Section Break
Complete Citation: Please print.
Journal/Book title, author, publisher, date, volume,
issue, Page # (For photocopied material, please also
write the citation on the first page.)
Who owns the
original?
Personal,
Torreyson Library
or another UCA
department/unit
Copyright
permission for
photocopies or
items outside
“fair use” guidelines
included? Yes/No Yes No
Any Additional Information