Instructor:

Your name:

School:

Phone:

Fax:

Email:

Course or subject:

Grade level:

Assignment name:

Due date:

Number of students doing assignment:

Description of assignment:

Students may use the following types of resources: (check all that apply)
Books
Magazines
Internet resources
Online databases
General encyclopedias
Specialized encyclopedias
Pamphlets
A/V materials

Place relevant materials on temporary reserve?
Yes
No

Materials the library should consider for purchase relevant to this assignment: