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KCMA library RESERVE REQUEST FORM

Please complete a form for each item to be placed on reserve.
Instructor's Name:
Department:
Email Address:
Phone Number:

Course Name and Number:

Item Information

Title:
Date or Edition:
Author (if available):
Call# (if available):
Material Source: (Select one)
    Personal Copy
    library copy
Material Type: (Select one)
    Book
    Article
    Audio
    Video
    Class Notes
    Sample Tests
Loan Period: (Select one)
    Library use only
    Overnight
    3 days
    Other

Because all reserve materials are subject to Copyright Law(P.L. 94-553, title 17 US Code), we ask that you confirm that the above materials will not violate this law before submitting your request. Click on Confirm if you certify that the above item is in compliance with Copyright Law P.L. 94-553, title 17 US Code). Forms submitted without confirmation of compliance cannot be processed.