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> Instruction Request Form
Instruction Request Form
* required
Course Number and Section*
i.e. - 102-0004
Course Name*
Location
Main Campus
Other
Number of Students*
Instructor Name*
Instructor Email*
Instructor Phone
Class meets*
M-W-F
T-Th
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Daily
Other
select one
7:40am-8:30am
7:40am-8:55am
8:00am-11:00am
8:40am-9:30am
9:15am-10:30am
9:40am-10:30am
10:40am-11:30pm
10:40am-11:55am
11:30am-2:30pm
11:40am-12:30pm
12:15pm-1:30pm
12:40pm-1:30pm
1:40pm-2:30pm
1:40pm-2:55pm
2:40pm-3:30pm
3:15pm-4:30pm
3:40pm-4:30pm
4:40pm-5:30pm
4:40pm-5:55pm
5:30pm-8:30pm
6:00pm-7:15pm
6:00pm-9:00pm
7:30pm-8:45pm
Other
Preferred date*
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2012
Alternate date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2012
Preferred Librarian (if any):
What would you like covered? Examples: finding articles, specialized index or database, etc.*
Briefly describe the project or assignment on which students will be working:*
Please describe any special accommodations your students will need:
Further Comments: